Topic

Washington

A collection of 489 issues

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

How to Get Filsuvez Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Filsuvez Covered by Humana in Washington Humana Medicare Advantage plans require prior authorization for Filsuvez (birch triterpenes topical gel) to treat confirmed dystrophic or junctional epidermolysis bullosa in patients ≥6 months old. Success requires genetic testing results (COL7A1, LAMA3), wound documentation (10-50 cm²), and failed prior treatments.
6 min read

How to Get Nucala (Mepolizumab) Covered by UnitedHealthcare in Washington: State Appeals Guide with Forms and Timelines

Answer Box: Getting Nucala Covered in Washington Washington residents have strong protections when UnitedHealthcare denies Nucala (mepolizumab) for severe eosinophilic asthma. State law requires step therapy exceptions within 72 hours if prior biologics failed or are contraindicated. After internal appeals, you can request binding external review through an Independent Review
6 min read

How to Get Tegsedi (Inotersen) Covered by Humana in Washington: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Tegsedi (Inotersen) Covered by Humana in Washington Note: Tegsedi was discontinued in September 2024 - verify current availability before proceeding. Getting Tegsedi covered by Humana requires prior authorization with specific documentation: genetic confirmation of hATTR polyneuropathy, specialist prescription, REMS enrollment, and baseline labs. In Washington, if denied,
5 min read

Myths vs. Facts: Getting Vigabatrin (Sabril) Covered by Humana in Washington - Complete Appeal Guide

Answer Box: Getting Vigabatrin Covered by Humana in Washington Eligibility: Humana requires prior authorization for vigabatrin (generic) and Sabril (brand) for infantile spasms and refractory seizures, with mandatory REMS program enrollment for prescriber, pharmacy, and patient before coverage consideration. Fastest path to approval: 1. Complete REMS enrollment at vigabatrinrems.com
5 min read

Renewing Lumizyme (Alglucosidase Alfa) Coverage with UnitedHealthcare in Washington: Annual Documentation Requirements and Timeline

Answer Box: Renewing Lumizyme Coverage with UnitedHealthcare in Washington UnitedHealthcare requires annual prior authorization renewal for Lumizyme (alglucosidase alfa) with documentation of continued clinical response. Start the renewal process 30-60 days before your current authorization expires. Submit updated pulmonary function tests, 6-Minute Walk Test results, and specialist notes showing stable
5 min read

How Long Does It Take to Get Orfadin (nitisinone) Approved by Aetna (CVS Health) in Washington? Timeline & Appeals

Answer Box: Timeline Overview Aetna (CVS Health) typically approves Orfadin (nitisinone) prior authorization requests within 72 hours for standard cases and 24 hours for expedited reviews in Washington. Over 95% of eligible requests are approved within 24 hours when complete documentation is submitted. Key requirements include confirmed hereditary tyrosinemia type
5 min read

How to Get Fintepla (fenfluramine) Covered by Blue Cross Blue Shield in Washington: Appeals Process, REMS Requirements, and State Protections

Answer Box: Getting Fintepla Covered by Blue Cross Blue Shield in Washington Fintepla (fenfluramine) requires prior authorization from Blue Cross Blue Shield with mandatory REMS enrollment and baseline echocardiography. To get approval: (1) Complete REMS enrollment at FinteplaREMS.com with baseline ECHO, (2) Submit PA with diagnosis confirmation (Dravet G40.
6 min read

Complete Guide: Getting Opsumit (Macitentan) Covered by UnitedHealthcare in Washington - Forms, Appeals & Timeline

Answer Box: Getting Opsumit Covered by UnitedHealthcare in Washington Opsumit (macitentan) requires prior authorization through OptumRx for all UnitedHealthcare plans in Washington. You'll need PAH diagnosis confirmed by right heart catheterization, WHO Functional Class II-IV documentation, and specialist prescriber. Submit via the UnitedHealthcare Provider Portal or fax to
6 min read