Topic

Washington

A collection of 408 issues

Renewing Tavalisse (Fostamatinib) Approval with UnitedHealthcare in Washington: Complete 2025 Guide

Answer Box: UnitedHealthcare requires annual renewal of Tavalisse (fostamatinib) prior authorization in Washington, with submissions due 30 days before expiration. Submit via the UHC Provider Portal with documented platelet response, current labs (LFTs, CBC, BP), and hematologist attestation. If denied, file internal appeal within 180 days, then external review through

How to Get Abecma (CAR-T Therapy) Covered by Cigna in Washington: Complete Appeals Guide with State Protections

Answer Box: Getting Abecma Covered by Cigna in Washington Abecma (idecabtagene vicleucel) requires prior authorization from Cigna for multiple myeloma patients who've had ≥4 prior therapies. Washington residents have strong appeal rights including binding external review after internal denials. Start today by: 1) Having your oncologist submit PA

How to Get Ultomiris (ravulizumab) Covered by Cigna in Washington: Forms, Appeals, and Patient Rights

Answer Box: Quick Path to Ultomiris Coverage To get Ultomiris (ravulizumab) covered by Cigna in Washington: Your doctor submits a prior authorization using Cigna's Ultomiris PA form via CoverMyMeds portal or fax (855) 840-1678. Include diagnosis-specific documentation (anti-AChR antibodies for gMG, anti-AQP4 for NMOSD), prior therapy failures, and

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Cigna in Washington: Appeals Guide with State Protections

Answer Box: Getting Enhertu Covered by Cigna in Washington Eligibility: Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization through Cigna's Express Scripts/Accredo for HER2-positive cancers. Fastest path: Submit PA with HER2+ test results, prior therapy failures, and oncologist's medical necessity letter. First step today: Call Cigna (number

How to Get Acthar Gel Covered by Humana in Washington: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Acthar Gel Covered by Humana in Washington Humana Medicare Advantage requires prior authorization for Acthar Gel (repository corticotropin injection) under their Corticotropin Products policy. Coverage applies to FDA-labeled indications like infantile spasms and MS exacerbations, with documented corticosteroid failure required for most conditions except infantile spasms. First

Renewing Stelara (Ustekinumab) Approval with Blue Cross Blue Shield in Washington: Complete 2025 Guide

Answer Box: Renewing Stelara Coverage in Washington To renew Stelara (ustekinumab) with Blue Cross Blue Shield in Washington: Submit updated clinical documentation 30-60 days before your current authorization expires. Include disease activity scores, treatment response data, recent labs (TB screening, CBC, liver function), and specialist notes. Most Washington BCBS plans

How to Get Voxzogo (Vosoritide) Covered by Humana in Washington: Appeals, Forms, and Provider Collaboration

Answer Box: Getting Voxzogo Covered by Humana in Washington Voxzogo (vosoritide) requires prior authorization from Humana for pediatric achondroplasia treatment. The fastest path to approval: (1) Have your pediatric endocrinologist or geneticist submit a complete PA request with FGFR3 genetic testing, growth plate imaging, and medical necessity documentation, (2) If

How to Get Enbrel (etanercept) Covered by Aetna CVS Health in Washington: Complete Coding, Appeals & Authorization Guide

Answer Box: Getting Enbrel (etanercept) Covered by Aetna CVS Health in Washington Quick path to approval: Submit prior authorization through Aetna's provider portal with proper ICD-10 codes (M05.9 for RA, M06.9 for seronegative RA), HCPCS J1438 billing code, tuberculosis/hepatitis B screening results, and documented failures

How to Get Naglazyme (galsulfase) Covered by Aetna (CVS Health) in Washington: Complete PA Guide & Appeal Scripts

Answer Box: Getting Naglazyme (galsulfase) Covered by Aetna (CVS Health) in Washington Naglazyme (galsulfase) requires prior authorization from Aetna (CVS Health) as a Tier 5 specialty medication for MPS VI (Maroteaux-Lamy syndrome). Your fastest path to approval: (1) Submit PA with confirmed enzyme/genetic testing showing ARSB deficiency, (2) Include

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

Answer Box: Fast Track to Vigabatrin Coverage To get vigabatrin covered by Blue Cross Blue Shield in Washington: First, ensure all parties (prescriber, patient/guardian, pharmacy) enroll in the federal Vigabatrin REMS program and complete baseline vision testing. Submit prior authorization with diagnosis confirmation (infantile spasms ≤2 years or refractory