Topic

Washington

A collection of 489 issues

How to Get Naglazyme (Galsulfase) Covered by UnitedHealthcare in Washington: Appeals Guide & Templates

Answer Box: Getting Naglazyme Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Naglazyme (galsulfase) enzyme replacement therapy for MPS VI. To get approval: (1) Submit PA with confirmed diagnosis via enzyme assay or genetic testing, (2) Include baseline functional measures like 6-minute walk test, and (3) If denied,

The Requirements Checklist to Get Evkeeza (evinacumab-dgnb) Covered by Cigna in Washington

Answer Box: Getting Evkeeza Covered by Cigna in Washington Fastest path to approval: Gather genetic HoFH confirmation, recent LDL-C levels (≥300 mg/dL while treated), and documented trials of maximally tolerated statin + ezetimibe + PCSK9 inhibitor. Submit Cigna's prior authorization form through their provider portal with specialist attestation. If

How to Get Increlex (mecasermin) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals & Step Therapy Exceptions

Answer Box: Getting Increlex Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Increlex (mecasermin) through OptumRx, with strict diagnostic criteria for severe primary IGF-1 deficiency. Your fastest path: (1) Have your pediatric endocrinologist submit a PA request with IGF-1 labs ≤ -3.0 SDS, growth hormone stimulation test results,

How to Get Soliris (Eculizumab) Covered by Cigna in Washington: Complete Prior Authorization Guide and Appeal Process

Answer Box: Getting Soliris Covered by Cigna in Washington To get Soliris (eculizumab) covered by Cigna in Washington, you need: (1) Complete prior authorization with diagnosis confirmation, vaccination records, and specialist documentation; (2) Submit via Cigna's provider portal or fax to 855.840.1678; (3) If denied, use

How to Get Myalept (Metreleptin) Approved by Aetna CVS Health in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Myalept (metreleptin) covered by Aetna CVS Health in Washington, you need: (1) confirmed generalized lipodystrophy diagnosis with ICD-10 code E88.12, (2) REMS program enrollment for both prescriber and pharmacy, and (3) documentation of failed conventional therapies. Submit via Aetna's provider portal with the

How to Get Galafold (migalastat) Covered by Aetna CVS Health in Washington: Step-by-Step Prior Authorization Guide with Appeals Process

Quick Answer: Getting Galafold Approved by Aetna CVS Health in Washington Eligibility: Adults with Fabry disease and a confirmed amenable GLA gene variant (eGFR ≥30 mL/min/1.73m²). Fastest path: Submit prior authorization with genetic test results, specialist prescription, and evidence of enzyme replacement therapy failure/contraindication. First step

How to Get Cystadane (betaine anhydrous) Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cystadane Covered in Washington UnitedHealthcare requires prior authorization for Cystadane (betaine anhydrous) with strict genetic testing and vitamin co-therapy documentation. Fastest path: Submit complete PA through OptumRx with genetic confirmation, elevated homocysteine labs, and documented B6/B12/folate trials. If denied, appeal internally within 180 days, then

Myths vs. Facts: Getting Spinraza (nusinersen) Covered by UnitedHealthcare in Washington

Answer Box: The Truth About Spinraza Coverage Myth: If your doctor prescribes Spinraza (nusinersen), UnitedHealthcare must cover it automatically. Fact: UnitedHealthcare requires prior authorization with genetic confirmation of 5q SMA, baseline motor function scores, and specialist attestation. Most denials stem from missing documentation, not medical necessity. In Washington, you have

How to Get Evkeeza (Evinacumab-dgnb) Covered by Humana in Washington: Complete Timeline & Appeals Guide

Answer Box: Getting Evkeeza Covered by Humana in Washington Evkeeza (evinacumab-dgnb) requires prior authorization from Humana with genetic confirmation of homozygous familial hypercholesterolemia (HoFH) and documented failure of standard lipid-lowering therapies. Standard review takes 30 days; expedited review 72 hours. If denied, you have 65 days to appeal internally, then

How to Get Hemlibra (emicizumab-kxwh) Covered by UnitedHealthcare in Washington: Complete Prior Authorization Guide

Quick Answer: Getting Hemlibra Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Hemlibra (emicizumab-kxwh) in Washington, with approval typically taking 14 days for standard requests. Your fastest path to approval: Have your hematologist submit the PA through the UnitedHealthcare Provider Portal with complete documentation including hemophilia A diagnosis,