Topic

Washington

A collection of 489 issues

Getting Firazyr (Icatibant) Covered by Aetna in Washington: Complete Prior Authorization & Appeals Guide

Quick Answer: To get Firazyr (icatibant) covered by Aetna in Washington, you need prior authorization through an HAE specialist with lab-confirmed C1-INH deficiency. Submit Aetna's precertification form with diagnosis documentation to 1-888-267-3277. If denied, appeal within 180 days, then request independent external review through Washington's IRO

Renewing Busulfex (Busulfan Injection) Approval with UnitedHealthcare in Washington: Complete Timeline & Documentation Guide

Answer Box: To renew Busulfex (busulfan injection) approval with UnitedHealthcare in Washington, start the prior authorization process 3-4 weeks before your next treatment cycle. Submit updated clinical documentation through the UnitedHealthcare Provider Portal, including recent labs, treatment response data, and therapeutic drug monitoring results. If denied, file an internal appeal

How to Get Revlimid (lenalidomide) Covered by Humana in Washington: Complete Decision Tree and Appeals Guide

Quick Answer: Most Humana Medicare Advantage plans in Washington require prior authorization for Revlimid (lenalidomide) with quantity limits and possible step therapy. Your fastest path to approval: (1) Confirm your diagnosis meets FDA criteria, (2) Have your doctor submit PA documentation to Humana at 1-877-486-2621, and (3) If denied, file

How to Get Eloctate Covered by Aetna CVS Health in Washington: Prior Authorization Guide, Appeals Process, and State Protection Rights

Answer Box: Getting Eloctate Covered by Aetna CVS Health in Washington Eloctate (efmoroctocog alfa) is covered as a preferred specialty drug by Aetna CVS Health in Washington but requires prior authorization from a hematologist. The fastest path to approval: (1) Have your hematologist submit a complete prior authorization with hemophilia

Renewing Mepsevii (vestronidase alfa-vjbk) Approval with Blue Cross Blue Shield in Washington: 2025 Requirements & Timeline

Answer Box: Blue Cross Blue Shield requires annual prior authorization renewal for Mepsevii (vestronidase alfa-vjbk) in Washington, with updated documentation 60-90 days before expiration. Key requirements: confirmed MPS VII diagnosis via enzyme/genetic testing, current specialist prescription, evidence of ongoing clinical benefit, and proper dosing verification. Start renewal preparation 3

If Zolgensma Isn't Approved by Aetna CVS Health in Washington: Spinraza, Evrysdi & Exception Paths

Answer Box: When Aetna Denies Zolgensma in Washington If Aetna CVS Health denies Zolgensma (onasemnogene abeparvovec) for your child with SMA, you have two main paths: formulary alternatives (Spinraza, Evrysdi) or formulary exception appeals. Both Spinraza and Evrysdi require prior authorization but have broader age eligibility than Zolgensma's

Myths vs. Facts: Getting iLink® Corneal Cross-Linking Covered by Humana in Washington

Answer Box: Fast Facts for Washington Residents Myth-busting reality: Humana covers FDA-approved iLink® corneal cross-linking for progressive keratoconus when strict medical necessity criteria are met. Over 95% of commercial plans cover this procedure, but prior authorization is required. Success depends on documented disease progression, proper clinical records, and using only

If Krystexxa (Pegloticase) Isn't Approved by Humana in Washington: Formulary Alternatives & Exception Paths

Answer Box: Humana Alternatives to Krystexxa in Washington If Humana denies Krystexxa (pegloticase), you must first try formulary alternatives—allopurinol, febuxostat, and typically probenecid—for at least 3 months each at maximum tolerated doses. Document treatment failures with serum uric acid levels >6 mg/dL, then request a formulary

Myths vs. Facts: Getting Gamifant (Emapalumab) Covered by Humana in Washington

Quick Answer: Gamifant Coverage by Humana in Washington Fact: Humana Medicare Advantage requires prior authorization for Gamifant (emapalumab) with strict HLH diagnostic criteria and conventional therapy failure documentation. Fastest path: Submit PA with HLH-2004 criteria proof, genetic testing results, and detailed records of failed etoposide/steroid therapy. First step today:

Requirements Checklist to Get Brineura (cerliponase alfa) Covered by Aetna (CVS Health) in Washington

Answer Box: Getting Started Aetna (CVS Health) requires prior authorization for Brineura (cerliponase alfa) with strict clinical criteria. Your fastest path to approval: confirm CLN2 diagnosis with genetic/enzyme testing, ensure treatment by a metabolic specialist at an approved infusion center, and submit complete documentation showing motor function assessment. Start