Topic

Washington

A collection of 233 issues

How Long Does It Take to Get Brensocatib (BRINSUPRI) Approved by UnitedHealthcare in Washington? Timeline & Appeal Guide

Quick Answer: Brensocatib (BRINSUPRI) Approval Timeline for UnitedHealthcare in Washington Standard timeline: 1-5 business days for prior authorization decisions once complete documentation is submitted. UnitedHealthcare requires prior authorization for Brensocatib with step therapy requirements (macrolide trial, airway clearance therapy). Expedited requests: 48-72 hours for life-threatening conditions. First step today: Gather

How to Get Myozyme (Alglucosidase Alfa) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Guide and Appeal Strategies

Answer Box: Getting Myozyme Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield (BCBS) plans in Washington require prior authorization for Myozyme (alglucosidase alfa) for Pompe disease. Success requires: (1) confirmed Pompe diagnosis with enzyme and genetic testing, (2) specialist involvement (metabolic/genetics/neurology), and (3) comprehensive

Do You Qualify for Opfolda (miglustat) Coverage by Aetna CVS Health in Washington? Decision Tree & Appeal Guide

Quick Answer: Opfolda Coverage by Aetna CVS Health in Washington Yes, you likely qualify if: You have confirmed late-onset Pompe disease (LOPD), are ≥18 years old and weigh >40 kg, have tried enzyme replacement therapy for ≥1 year without adequate improvement, and have a specialist prescribing Opfolda with Pombiliti

How to Get Opfolda (miglustat) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Guide, Appeals Process, and State Protection Rights

Quick Answer: Getting Opfolda Covered by Blue Cross Blue Shield in Washington Opfolda (miglustat) requires prior authorization from Blue Cross Blue Shield in Washington. The fastest path: 1) Have your doctor submit a PA request with documentation showing you're an adult (≥40 kg) with LOPD not improving on

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