Topic

Washington

A collection of 489 issues

How to Get Dojolvi (Triheptanoin) Covered by Aetna CVS Health in Washington: Complete Coding, Prior Auth & Appeals Guide

Answer Box: Getting Dojolvi Covered by Aetna CVS Health in Washington Fastest path to approval: Submit a specialty drug prior authorization request with molecular LC-FAOD confirmation (ICD-10 E71.318), discontinuation of MCT products, and metabolic specialist oversight. Use HCPCS J8499 with correct NDC for billing. If denied, Washington residents have

Get Xenpozyme (Olipudase Alfa) Covered by Humana in Washington: Complete Decision Tree & Appeal Guide

Answer Box: Your Fastest Path to Approval If you have confirmed ASMD (Niemann-Pick Type B or A/B) and meet Humana's criteria, expect 1-30 days for prior authorization approval. Your first step today: Have your doctor submit a prior authorization request through Humana's provider portal with

How to Get Onivyde (Irinotecan Liposome) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Guide and Appeals Process

Answer Box: Getting Onivyde Covered in Washington Blue Cross Blue Shield in Washington requires prior authorization for Onivyde (irinotecan liposome), typically covering it for metastatic pancreatic cancer when used in combination regimens like NALIRIFOX. Key requirements include ECOG performance status 0-1, documented diagnosis, and detailed clinical justification. If denied, you

How to Get Defitelio (defibrotide) Covered by Aetna CVS Health in Washington: Complete Prior Authorization Guide

Quick Answer: Defitelio (defibrotide) requires prior authorization from Aetna CVS Health for FDA-approved hepatic VOD/SOS treatment post-HSCT. Submit clinical documentation showing VOD diagnosis plus renal/pulmonary dysfunction through CVS Specialty Pharmacy. If denied, use Washington's external review process within 180 days. Start by gathering transplant records, diagnosis

UnitedHealthcare's Coverage Criteria for Upstaza (Eladocagene Exuparvovec) in Washington: What Counts as "Medically Necessary"?

Answer Box: UnitedHealthcare requires prior authorization for Upstaza (eladocagene exuparvovec) gene therapy, demanding genetic confirmation of DDC mutations, biochemical proof of AADC deficiency, and administration at a certified gene therapy center. If denied, Washington residents can appeal through internal review, then request external review through an Independent Review Organization (IRO)

How to Get Busulfex (busulfan injection) Covered by Humana in Washington: Appeals Process, Forms, and State Protections

Answer Box: Getting Busulfex Covered by Humana in Washington Busulfex (busulfan injection, J0594) requires prior authorization from Humana and may be subject to step therapy requirements for bone marrow transplant conditioning. In Washington, you have strong state protections including medical exceptions to step therapy and external review through Independent Review

How to Get Haegarda (C1-Esterase Inhibitor) Covered by Aetna CVS Health in Washington: Complete Appeals Guide

Quick Answer: Getting Haegarda Covered by Aetna CVS Health in Washington To get Haegarda (C1-esterase inhibitor, SC) covered by Aetna CVS Health in Washington, you need prior authorization with specific documentation: confirmed HAE diagnosis with lab results (C1-INH levels below normal), specialist consultation, and proof you won't use

Getting Elzonris (Tagraxofusp-erzs) Covered by UnitedHealthcare in Washington: Complete PA Guide

Answer Box: Your Fastest Path to Coverage UnitedHealthcare requires prior authorization for Elzonris (tagraxofusp-erzs) and places it on specialty tier. To get approved in Washington: 1) Gather pathology confirming CD123+ BPDCN, recent labs, and clinical notes, 2) Submit PA through the UnitedHealthcare Provider Portal with complete documentation, 3) If denied,

How to Get Natpara (Parathyroid Hormone) Covered by Blue Cross Blue Shield in Washington: Appeals Guide with Forms and Deadlines

Quick Answer: Getting Natpara Covered by Blue Cross Blue Shield in Washington Important: Natpara is being discontinued globally, with U.S. shipments ending December 31, 2025. New patient approvals are extremely rare due to supply cessation. For existing patients or those seeking alternatives, here's your fastest path: 1.

Getting Xembify (Immune Globulin) Covered by Aetna in Washington: Complete Guide to Prior Authorization and Appeals

Quick Answer: Aetna requires prior authorization for Xembify in Washington. Start by having your doctor submit a Statement of Medical Necessity with your primary immunodeficiency diagnosis, infection history, and lab results. If denied, you can appeal internally and then request an external review through Washington's Office of Insurance