Topic

Washington

A collection of 488 issues

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

Answer Box: Getting Garadacimab Covered by BCBS in Washington Garadacimab (Andembry) requires prior authorization from Blue Cross Blue Shield plans in Washington. Submit a formulary exception request with confirmed HAE diagnosis (ICD-10 D84.1), lab results showing low C4 and C1-INH levels, and documentation of prior therapy failures. If denied,
6 min read

How to Get Sylvant (Siltuximab) Covered by Humana in Washington: Complete PA Guide and Appeals Process

Answer Box: Getting Sylvant (Siltuximab) Covered by Humana in Washington Humana requires prior authorization for Sylvant (siltuximab) to treat HIV-negative, HHV-8-negative multicentric Castleman disease. Your provider submits the PA request via Humana's provider portal with documentation of failed prior therapies (rituximab, corticosteroids, or chemotherapy), HIV/HHV-8 test results,
6 min read

How to Get Firazyr (Icatibant) Covered by Cigna in Washington: Appeals Process, Forms, and State Protections

Quick Answer: Getting Firazyr (Icatibant) Covered by Cigna in Washington Firazyr (icatibant) requires prior authorization from Cigna, typically managed through Express Scripts/Accredo. If denied, Washington residents have strong appeal rights: internal appeals within 180 days, followed by binding external review through an Independent Review Organization (IRO) within 120 days.
5 min read

How to Get Brineura (Cerliponase Alfa) Covered by Humana in Washington: Prior Authorization Guide and Appeals Process

Answer Box: Getting Brineura Covered by Humana in Washington Brineura (cerliponase alfa) requires prior authorization from Humana for CLN2 disease patients ≥3 years old. Submit a formulary exception request with medical necessity documentation including TPP1 enzyme deficiency confirmation, specialized center capability, and neurosurgical device placement plans. If denied, you have
5 min read

How to Get Stelara (ustekinumab) Covered by Aetna (CVS Health) in Washington: Complete Guide to Prior Authorization, Appeals, and External Review

Answer Box: Getting Stelara (ustekinumab) Covered by Aetna (CVS Health) in Washington Stelara requires prior authorization from Aetna with step therapy requirements (failed conventional treatments like methotrexate or TNF inhibitors), negative TB screening within 12 months, and specialist documentation. Fastest path: Call Aetna at 1-888-632-3862 to confirm your plan'
6 min read

How Long Does It Take to Get Abecma (idecabtagene vicleucel) Approved by Blue Cross Blue Shield in Washington? Complete Timeline & Appeals Guide

Answer Box: Fastest Path to Abecma Approval Blue Cross Blue Shield plans in Washington (Premera, Regence) typically process Abecma prior authorization in 1-5 business days for standard requests, 72 hours for urgent cases. Submit complete documentation including ≥2 prior therapy failures (IMiD, proteasome inhibitor, anti-CD38), recent labs, and treatment at
6 min read

How to Get Elaprase (idursulfase) Covered by UnitedHealthcare in Washington: Prior Authorization Guide and Appeal Process

Answer Box: Getting Elaprase (idursulfase) Covered in Washington To get Elaprase (idursulfase) approved by UnitedHealthcare in Washington, you need: (1) prior authorization with genetic/enzymatic confirmation of Hunter syndrome (MPS II), (2) weight-based dosing calculations, and (3) an infusion monitoring plan. If denied, Washington gives you 60 days to request
7 min read