Topic

Washington

A collection of 54 issues

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

Answer Box: Fast Track to Approval Getting Ilaris (canakinumab) covered by Blue Cross Blue Shield in Washington requires prior authorization with specific documentation. Here's the fastest path: 1. Gather diagnostic evidence: Yamaguchi criteria for AOSD or ILAR criteria for SJIA, plus elevated inflammatory markers (ESR, CRP, ferritin >

Renewing Voxzogo (Vosoritide) Approval with UnitedHealthcare in Washington: 2025 Requirements & Timeline

Quick Answer: Voxzogo Renewal Requirements UnitedHealthcare requires annual reauthorization for Voxzogo (vosoritide) with documented clinical response and open epiphyses. Start renewal 60 days before expiration. Key documents: updated growth data showing improved velocity, bone age confirmation of open growth plates, and provider attestation of continued benefit. Submit through OptumRx provider

How to Get Arikayce Covered by Humana in Washington: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Arikayce Covered by Humana in Washington Arikayce (amikacin liposome inhalation) requires prior authorization from Humana and is typically approved only for refractory MAC lung disease after 6+ months of failed standard therapy. In Washington, if denied, you have 60 days to request external review through an Independent

How to Get Entresto (sacubitril/valsartan) Covered by Humana in Washington: Appeals Guide & Templates

Quick Answer: Getting Entresto Covered by Humana in Washington Entresto requires prior authorization from Humana and is typically covered as a Tier 3 medication. If denied, you have 65 days to appeal. The fastest path: 1) Have your cardiologist submit a medical necessity letter documenting your heart failure diagnosis with

How Long Does It Take to Get Rylaze Approved by Blue Cross Blue Shield in Washington? Complete Timeline & Appeal Guide

Answer Box: Rylaze Approval Timeline in Washington Blue Cross Blue Shield Washington typically processes Rylaze prior authorization in 72 hours for urgent cases and 5-7 business days for standard requests. You'll need documented hypersensitivity to E. coli asparaginase, ALL/LBL diagnosis, and oncologist prescription. If denied, internal appeals

Work With Your Doctor to Get Epidiolex (Cannabidiol) Covered by Cigna in Washington: Complete Provider Collaboration Guide

Answer Box: Getting Cigna to Cover Epidiolex in Washington To get Epidiolex (cannabidiol) covered by Cigna in Washington, you need prior authorization with documented diagnosis of Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex, plus evidence of failed alternative seizure medications. Your neurologist must complete Cigna's PA form

How to Get Berinert (C1-esterase inhibitor, IV) Covered by Humana in Washington: Complete Prior Authorization Guide

Answer Box: Getting Berinert Covered by Humana in Washington Humana requires prior authorization for Berinert (C1-esterase inhibitor, IV) for hereditary angioedema treatment. The fastest path to approval: (1) Submit PA request through CoverMyMeds with complete HAE diagnosis documentation, (2) Include evidence of failed alternative therapies or contraindications, and (3) Use

Do You Qualify for Pemazyre (Pemigatinib) Coverage by Cigna in Washington? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Pemazyre Coverage Yes, you can get Pemazyre (pemigatinib) covered by Cigna in Washington if you have unresectable/metastatic cholangiocarcinoma with FGFR2 fusion/rearrangement and prior systemic therapy. The fastest path: 1) Confirm FGFR2 testing is complete, 2) Submit Cigna's prior authorization with

How to Get Elelyso (Taliglucerase Alfa) Covered by Humana in Washington: Complete Guide with Appeals Process

Quick Answer: Getting Elelyso Covered by Humana in Washington Elelyso (taliglucerase alfa) requires prior authorization from Humana. You'll need: confirmed Type 1 Gaucher disease diagnosis (enzyme deficiency + genetic testing), specialist prescriber (hematologist/endocrinologist), and clinical documentation showing medical necessity. If denied, Washington offers strong appeal rights including binding

How to Get Onivyde (Irinotecan Liposome) Covered by Humana in Washington: Prior Authorization, Appeals & Network Requirements

Answer Box: Getting Onivyde Covered by Humana in Washington Humana covers Onivyde (irinotecan liposome) in Washington, but requires prior authorization (PA) for all regimens. The NALIRIFOX combination (Onivyde + oxaliplatin + 5-FU + leucovorin) is FDA-approved for first-line metastatic pancreatic cancer as of February 2024. Fastest path to approval: 1. Submit PA request