Topic

Washington

A collection of 489 issues

UnitedHealthcare Coverage for Oxbryta (Voxelotor) in Washington: 2024 FDA Withdrawal and Alternative Options

Answer Box: Oxbryta Coverage Status Oxbryta (voxelotor) is no longer available and cannot be covered by UnitedHealthcare or any insurer. Pfizer voluntarily withdrew the drug in September 2024 following FDA safety review. Your fastest path forward: Work with your hematologist to transition to FDA-approved alternatives like hydroxyurea, L-glutamine, or crizanlizumab.

How to Get Natpara (Parathyroid Hormone) Covered by Cigna in Washington: Complete 2025 Discontinuation Guide

Answer Box: Getting Natpara Covered by Cigna in Washington Critical Update: Natpara was discontinued by Takeda on December 31, 2024. Existing patients have access through the Special Use Program until December 31, 2025, but new prescriptions are generally denied due to lack of commercial supply. For current patients: Submit prior

Coding That Helps Get Jaypirca (Pirtobrutinib) Approved by Aetna (CVS Health) in Washington: ICD-10, HCPCS J-Code, and NDC Guide

Answer Box: Getting Jaypirca (Pirtobrutinib) Approved by Aetna (CVS Health) in Washington Key codes needed: ICD-10 C83.1 (mantle cell lymphoma) or C91.1/C83.0 (CLL/SLL) with relapse status; HCPCS J9399; NDC varies by strength. Fastest approval path: Submit prior authorization through CVS Caremark with complete documentation of

Do You Qualify for Turalio (Pexidartinib) Coverage by Humana in Washington? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Turalio Coverage Likely eligible if you have: Confirmed TGCT diagnosis via MRI, surgery documented as inappropriate due to morbidity risks, and completed REMS enrollment. First step today: Have your prescriber verify REMS certification at TuralioREMS.com and gather MRI reports showing TGCT diagnosis. Timeline:

If Darzalex Isn't Approved by UnitedHealthcare in Washington: Formulary Alternatives & Exception Paths

Answer Box: When Darzalex Isn't Your First Option If UnitedHealthcare denies Darzalex (daratumumab) in Washington, you have proven alternatives and exception paths. Fastest approach: Try formulary alternatives like Sarclisa (isatuximab) or proteasome inhibitors first, document response/failure thoroughly, then request a Darzalex exception with clinical evidence. Start today:

How to Get Uptravi (Selexipag) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Uptravi (Selexipag) Covered by Humana in Washington Humana requires prior authorization for Uptravi (selexipag) under Medicare Advantage plans. To get approved: (1) Have your pulmonologist or cardiologist submit a complete prior authorization with hemodynamic confirmation of WHO Group I PAH, documentation of failed step therapy with at

How to Get Vigabatrin Covered by Cigna in Washington: Prior Authorization Forms, Appeals, and REMS Requirements

Quick Answer: To get Vigabatrin covered by Cigna in Washington, you need: (1) REMS program enrollment for patient, prescriber, and pharmacy, (2) baseline vision testing by an ophthalmologist, (3) prior authorization submission with diagnosis codes and failed therapy documentation. Start by confirming REMS enrollment status—this is the most common

UnitedHealthcare's Coverage Criteria for Synagis (Palivizumab) in Washington: What Counts as "Medically Necessary"?

Answer Box: Getting Synagis Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for all Synagis (palivizumab) prescriptions with strict high-risk pediatric criteria. You must prove why Beyfortus (nirsevimab) isn't appropriate first. Fast track: Submit PA through the UnitedHealthcare Provider Portal with complete cardiology/pulmonology notes, birth certificate,

Renewing Prolastin-C (Alpha1-Proteinase Inhibitor) Approval with Aetna CVS Health in Washington: Timeline, Documentation & Appeal Guide

Answer Box: Renewing Prolastin-C Coverage with Aetna CVS Health Start your renewal 90 days early. Aetna typically approves Prolastin-C for 3-6 months initially, then 12-month renewals. You'll need updated AAT levels, FEV1 results, and proof of clinical benefit. Submit 60 days before expiration through CVS Caremark or your

How to Get Trikafta Covered by Aetna CVS Health in Washington: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Trikafta Covered by Aetna CVS Health in Washington Trikafta requires prior authorization from Aetna CVS Health before coverage. The fastest path to approval: your CF specialist submits a PA request with CFTR genotype results, baseline liver function tests, and medical necessity documentation. If denied, request a peer-to-peer