Topic

Washington

A collection of 489 issues

How to Get Sylvant (Siltuximab) Covered by UnitedHealthcare in Washington: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Sylvant Covered by UnitedHealthcare in Washington Sylvant (siltuximab) requires mandatory prior authorization from UnitedHealthcare for multicentric Castleman disease. To get approved: 1) Verify HIV-negative and HHV-8-negative lab results are current, 2) Have your oncologist submit PA request through the UnitedHealthcare Provider Portal with complete pathology and clinical

The Requirements Checklist to Get Gamifant (emapalumab-lzsg) Covered by UnitedHealthcare in Washington: PA Forms, Appeal Deadlines & Documentation

Answer Box: Your Fastest Path to Gamifant Coverage Who qualifies: Patients with primary hemophagocytic lymphohistiocytosis (HLH) who've failed conventional therapy (etoposide + steroids). Fastest approval: Submit prior authorization through UnitedHealthcare provider portal with complete HLH-2004 criteria documentation and step therapy failure records. Start today: Contact your hematologist to request

How to Get Synagis (Palivizumab) Covered by Aetna in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Synagis Approved by Aetna in Washington Aetna requires prior authorization for Synagis (palivizumab) and prioritizes Beyfortus as first-line therapy. To get coverage in Washington: (1) Submit Aetna's Synagis precertification form with clinical documentation proving high-risk criteria, (2) demonstrate why Beyfortus is contraindicated or inappropriate, and

How to Get Crysvita (Burosumab) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Crysvita Covered in Washington Yes, Blue Cross Blue Shield covers Crysvita (burosumab) in Washington with prior authorization. The fastest path: 1) Have your endocrinologist submit PA with genetic testing, biochemical labs (serum phosphate, FGF23), and step therapy documentation, 2) If denied, file internal appeal within 180 days,

How to Get Tysabri (Natalizumab) Covered by UnitedHealthcare in Washington: Appeals, Prior Authorization & State Protections

Quick Answer: Getting Tysabri Covered in Washington UnitedHealthcare requires prior authorization for Tysabri (natalizumab) through OptumRx before dispensing. You must be enrolled in the FDA-required TOUCH program and provide documentation of multiple sclerosis diagnosis with prior treatment failures. If denied, you have 180 days to file an internal appeal, followed

Myths vs. Facts: Getting Ocrevus (ocrelizumab) Covered by Blue Cross Blue Shield in Washington

Answer Box: Getting Ocrevus Covered by Blue Cross Blue Shield in Washington Eligibility: Ocrevus requires prior authorization from Blue Cross Blue Shield Washington plans. New requests effective March 10, 2025 require failure of 2+ disease-modifying therapies including natalizumab for relapsing MS, or confirmed primary progressive MS diagnosis under age 55.

Work With Your Doctor to Get Strensiq (Asfotase Alfa) Approved by Blue Cross Blue Shield in Washington: Complete Provider Collaboration Guide

Answer Box: Your Path to Strensiq Approval in Washington To get Strensiq (asfotase alfa) covered by Blue Cross Blue Shield in Washington, you'll need: (1) documented pediatric-onset hypophosphatasia with genetic/biochemical confirmation, (2) a comprehensive medical necessity letter from your specialist, and (3) baseline ophthalmology and renal imaging.

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

Answer Box: Getting Bavencio Covered by Cigna in Washington Bavencio requires prior authorization from Cigna. The fastest path: 1) Have your oncologist submit the Cigna prior authorization form with complete platinum chemotherapy history and imaging within 8 weeks, 2) If denied, file internal appeal within 180 days emphasizing medical necessity,

UnitedHealthcare's Coverage Criteria for Vyndaqel/Vyndamax (Tafamidis) in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vyndaqel/Vyndamax Covered by UnitedHealthcare in Washington Fastest path to approval: Submit prior authorization with confirmed ATTR-CM diagnosis (PYP scan grade 2/3 or biopsy), NYHA Class I-III status, and negative light chain testing. UnitedHealthcare requires cardiology oversight and 12-month reauthorization. If denied, you have 60 days

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by Blue Cross Blue Shield in Washington: Complete PA Guide with Forms and Appeals

Answer Box: Getting HyperHEP Covered in Washington Blue Cross Blue Shield plans in Washington require prior authorization for HyperHEP (hepatitis B immune globulin). To get approved: 1) Have your provider submit a PA request through Availity Essentials with exposure documentation and CDC guideline references, 2) Include timing (within 7 days