Topic

Washington

A collection of 232 issues

Renewing Koselugo (Selumetinib) Approval with UnitedHealthcare in Washington: 2025 Requirements & Timeline

Answer Box: Renewing Koselugo with UnitedHealthcare in Washington UnitedHealthcare requires prior authorization renewal for Koselugo (selumetinib) every 12 months for pediatric NF1 patients. Start renewal 30-60 days early with updated MRI showing stable/improved plexiform neurofibromas, specialist notes documenting continued benefit, and cardiac/eye monitoring results. Submit through the UnitedHealthcare

How to Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in Washington: Complete PA Guide and Appeal Process

Answer Box: Getting Venclexta (venetoclax) Covered by Aetna (CVS Health) in Washington Venclexta requires prior authorization from Aetna (CVS Health) for all indications. The fastest path to approval: (1) Document prior therapy failures (BTK inhibitors for CLL, appropriate treatments for AML), (2) Submit complete PA with tumor lysis syndrome prevention

Myths vs. Facts: Getting Hetlioz (Tasimelteon) Covered by Cigna in Washington

Answer Box: Hetlioz Coverage Through Cigna in Washington Myth: If your doctor prescribes Hetlioz, Cigna automatically covers it. Fact: Cigna requires prior authorization with documented step therapy (ramelteon + one other sleep medication failure) and specialist confirmation of Non-24-Hour Sleep-Wake Disorder or Smith-Magenis Syndrome. Submit PA forms through the Cigna provider

How to Get Sumavel DosePro Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide (2024)

Important Update: Sumavel DosePro (needle-free sumatriptan injection) was discontinued in the U.S. in 2018. While this guide covers the approval process that would apply if it were available, patients seeking injectable sumatriptan should work with their doctor to access available needle-based auto-injector alternatives through Cigna's formulary. Quick

How to Get Takhzyro (lanadelumab-flyo) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Takhzyro Covered by Blue Cross Blue Shield in Washington To get Takhzyro (lanadelumab-flyo) approved by Blue Cross Blue Shield in Washington, you need: (1) confirmed HAE Type I or II diagnosis with C1-INH and C4 lab results, (2) documentation of failed or contraindicated alternatives like Haegarda or

How to Get Qinlock (Ripretinib) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Qinlock Covered by Cigna in Washington Qinlock (ripretinib) requires prior authorization from Cigna for fourth-line GIST treatment. You'll need documented failure of three prior kinase inhibitors (imatinib, sunitinib, regorafenib), pathology confirming GIST diagnosis, and recent imaging showing disease progression. Submit through your oncologist to Cigna&

How to Get Filsuvez (Birch Triterpenes Topical Gel) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Filsuvez Covered by Cigna in Washington Eligibility: Cigna covers Filsuvez for dystrophic or junctional epidermolysis bullosa patients ≥6 months old with confirmed genetic diagnosis and clean wounds 10-50 cm² that are 21+ days but <9 months old. Fastest Path: Have your dermatologist submit prior authorization through

Get Alprolix Covered by Humana in Washington: Prior Authorization Guide with Appeal Templates

Quick Answer: Alprolix requires prior authorization from Humana Medicare plans. Your hematologist must submit clinical documentation showing hemophilia B diagnosis, factor IX levels ≤2%, and bleeding history. Standard approval takes 72 hours; expedited reviews take 24 hours. If denied, you have 65 days to appeal and can request Washington'

Getting Translarna (Ataluren) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Translarna Coverage To get Translarna (ataluren) covered by Blue Cross Blue Shield in Washington, you need: 1. Genetic confirmation of nonsense mutation DMD via molecular testing 2. Ambulatory status documentation (6-minute walk test within 6 months) 3. Prior authorization submission through your BCBS provider portal

How Long Does It Take to Get Brensocatib (BRINSUPRI) Approved by UnitedHealthcare in Washington? Timeline & Appeal Guide

Quick Answer: Brensocatib (BRINSUPRI) Approval Timeline for UnitedHealthcare in Washington Standard timeline: 1-5 business days for prior authorization decisions once complete documentation is submitted. UnitedHealthcare requires prior authorization for Brensocatib with step therapy requirements (macrolide trial, airway clearance therapy). Expedited requests: 48-72 hours for life-threatening conditions. First step today: Gather