Topic

Washington

A collection of 489 issues

How to Get Kalydeco (ivacaftor) Covered by Blue Cross Blue Shield in Washington: Costs, Appeals, and Financial Assistance

Quick Answer: Getting Kalydeco (ivacaftor) Covered in Washington Blue Cross Blue Shield (BCBS) plans in Washington require prior authorization for Kalydeco (ivacaftor) with documented CFTR mutation testing. Most plans place it on specialty tiers (Tier 5-6) with costs ranging from $3,500-$8,950 monthly depending on your coverage. First

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Humana in Washington: Complete Decision Tree & Appeals Guide

Answer Box: Your Path to Vyndaqel/Vyndamax Coverage Getting Vyndaqel/Vyndamax (tafamidis) covered by Humana in Washington requires prior authorization with confirmed ATTR-CM diagnosis and cardiology oversight. Start by ensuring your cardiologist has documented evidence of transthyretin amyloid cardiomyopathy (PYP scan Grade 2/3 with negative monoclonal protein screen, or

Work With Your Doctor to Get Taltz (Ixekizumab) Approved by UnitedHealthcare in Washington: Complete Guide

Answer Box: Getting Taltz Approved by UnitedHealthcare in Washington Eligibility: Taltz (ixekizumab) requires prior authorization from UnitedHealthcare for moderate-to-severe plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. Most plans require step therapy with preferred biologics first. Fastest Path: 1) Complete TB screening and gather PASI scores/functional assessments, 2) Document failure

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

Answer Box: Getting Alecensa Covered by Aetna CVS Health in Washington Alecensa (alectinib) is covered by Aetna CVS Health as a Tier 4 specialty medication with mandatory prior authorization. To get approved in Washington: 1. Confirm ALK-positive status with FDA-approved testing results 2. Submit CVS Specialty enrollment form with complete

Work With Your Doctor to Get Exondys 51 (Eteplirsen) Covered by Cigna in Washington: Complete Guide

Answer Box: Getting Exondys 51 Covered by Cigna in Washington What you need: Genetic testing confirming DMD with exon 51-amenable mutation, neurologist prescription, functional assessments (6-minute walk test), and cardiac/pulmonary baseline testing. Fastest path: 1) Schedule visit with neuromuscular specialist, 2) Gather genetic reports and functional testing, 3) Submit

How to Get Vimizim (Elosulfase Alfa) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Vimizim Covered by Cigna in Washington To get Vimizim (elosulfase alfa) covered by Cigna in Washington, you'll need prior authorization with specific documentation: confirmed MPS IVA diagnosis (enzyme or genetic testing), prescription from a geneticist or metabolic specialist, baseline 6-minute walk test, and age ≥5

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

Answer Box: Your Path to Pemazyre Coverage Most patients with FGFR2 fusion-positive cholangiocarcinoma or FGFR1-rearranged myeloid/lymphoid neoplasms qualify for Pemazyre coverage by Humana in Washington. The fastest path: ensure you have documented FGFR testing results, complete baseline ophthalmologic exam, and submit prior authorization with these documents via your prescriber.

Resources to Get Lutathera (Lutetium Lu-177 Dotatate) Approved with UnitedHealthcare in Washington: Forms, Portals & Appeals Guide

Answer Box: Getting Lutathera Covered by UnitedHealthcare in Washington Lutathera requires prior authorization from UnitedHealthcare with strict clinical criteria. The fastest path: Submit through the UnitedHealthcare Provider Portal with complete documentation including SSTR-positive imaging, GEP-NET diagnosis, and disease progression on octreotide. If denied, file internal appeals within 180 days, then

How to Get Uptravi (Selexipag) Covered by UnitedHealthcare in Washington: Forms, Appeals & Contacts

Answer Box: Getting Uptravi Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Uptravi (selexipag) in Washington. The fastest path to approval: 1) Verify your plan's formulary status and PA requirements through the UnitedHealthcare provider portal, 2) Submit complete clinical documentation including confirmed WHO Group I PAH

If Ruconest Isn't Approved by Humana in Washington: Formulary Alternatives & Exception Paths

Answer Box: Ruconest Alternatives & Exception Strategy If Humana denies Ruconest for hereditary angioedema (HAE) in Washington, you have three paths: try covered alternatives first (Berinert for acute attacks, lanadelumab for prevention), request a formulary exception with medical necessity documentation, or appeal through Washington's external review process. Start