Topic

Washington

A collection of 489 issues

How to Get Imbruvica (Ibrutinib) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Templates

Answer Box: Getting Imbruvica Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Imbruvica (ibrutinib) but doesn't mandate step therapy for CLL, SLL, or Waldenström macroglobulinemia. The fastest path: (1) Submit complete PA with pathology, diagnosis, and treatment history; (2) If denied, file internal appeal within 180

How to Get Tagrisso (Osimertinib) Covered by UnitedHealthcare in Washington: Prior Authorization Guide & Appeal Steps

Answer Box: Getting Tagrisso Covered by UnitedHealthcare in Washington You can get Tagrisso (osimertinib) covered by UnitedHealthcare in Washington if you have EGFR-mutated non-small cell lung cancer (NSCLC) and meet prior authorization criteria. The fastest path: ensure your oncologist has documented EGFR mutation test results (exon 19 deletion or L858R)

How to Get Filspari (Sparsentan) Covered by Blue Cross Blue Shield in Washington: 2025 Forms, Appeals & Contacts

Answer Box: Getting Filspari Covered in Washington Filspari (sparsentan) requires prior authorization and REMS program enrollment for Blue Cross Blue Shield coverage in Washington. Your fastest path: (1) Enroll prescriber and patient in the Filspari REMS program, (2) Submit the PA form via your plan's provider portal (Availity

Myths vs. Facts: Getting Ultomiris (Ravulizumab) Covered by UnitedHealthcare in Washington

Answer Box: Getting Ultomiris Covered by UnitedHealthcare in Washington Eligibility: UnitedHealthcare requires prior authorization for Ultomiris (ravulizumab) with step therapy—typically trying eculizumab first. Fastest path: Submit complete PA documentation including diagnosis confirmation (PNH flow cytometry, AChR+ for gMG, AQP4+ for NMOSD), vaccination records, and prior therapy failures. First step

How to Get Pomalyst (pomalidomide) Covered by Cigna in Washington: Complete Appeals Guide with Forms and Timelines

Quick Answer: To get Pomalyst (pomalidomide) covered by Cigna in Washington, you need prior authorization proving you've failed lenalidomide and a proteasome inhibitor, are 18+, and will use it with dexamethasone. Submit through Cigna's provider portal with complete treatment history. If denied, you have 180 days

Renewing Jaypirca (Pirtobrutinib) Coverage with Humana in Washington: 2025 Requirements & Timeline

Quick Answer: Renewing Your Jaypirca Coverage Humana requires annual prior authorization renewal for Jaypirca (pirtobrutinib). Start the renewal process 60-90 days before your current authorization expires. You'll need updated clinical documentation showing continued disease response or stability, absence of unacceptable toxicity, and ongoing medical necessity. Submit through Humana&

Complete Guide to Getting Duopa Covered by Blue Cross Blue Shield in Washington: Requirements, Forms, and Appeals Process

Answer Box: Getting Duopa Covered by Blue Cross Blue Shield in Washington Duopa requires prior authorization from Blue Cross Blue Shield (BCBS) in Washington. To get approved: (1) Your neurologist submits a PA request with documentation of advanced Parkinson's disease, failed oral therapies, and 2+ hours daily "

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Humana in Washington: Complete Decision Tree & Appeals Guide

Answer Box: Your Path to Besponsa Coverage Getting Besponsa (inotuzumab ozogamicin) covered by Humana in Washington requires meeting specific criteria for relapsed/refractory CD22-positive ALL. Most approvals happen within 72 hours if you submit complete documentation upfront. Your first step today: Confirm CD22-positive status via flow cytometry and gather prior

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

Quick Answer: Getting Fintepla Covered by Aetna CVS Health in Washington Fintepla (fenfluramine) requires prior authorization from Aetna CVS Health for patients with Dravet syndrome or Lennox-Gastaut syndrome (ages 2+). The fastest path to approval: (1) Ensure REMS enrollment and baseline echocardiogram are complete, (2) Submit Aetna's PA

How to Get Cerezyme (Imiglucerase) Covered by Humana in Washington: Complete Guide with Forms and Appeals

Answer Box: Getting Cerezyme Covered by Humana in Washington Cerezyme (imiglucerase) requires prior authorization from Humana Medicare Advantage plans. Your fastest path to approval: 1) Confirm Type 1 Gaucher disease diagnosis with enzyme testing and genetic analysis, 2) Submit complete prior authorization request through Humana's provider portal with