Topic

Washington

A collection of 489 issues

Getting Orfadin (Nitisinone) Covered by Humana in Washington: Prior Authorization, Appeals & Alternative Options

Answer Box: Getting Orfadin (Nitisinone) Covered by Humana in Washington Orfadin (nitisinone) requires prior authorization from Humana in Washington. To get approved: (1) Your doctor submits a prior authorization request with HT-1 diagnosis documentation, (2) Humana responds within 72 hours (24 hours if expedited), (3) If denied, you have 65

How to Get Keytruda (Pembrolizumab) Covered by Cigna in Washington: Complete Guide to Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Keytruda Covered by Cigna in Washington Keytruda (pembrolizumab) requires prior authorization from Cigna and is typically dispensed through their specialty pharmacy, Accredo. First step: Your oncologist submits a PA request via CoverMyMeds or SureScripts with complete clinical documentation. If denied, you have 180 days to appeal internally,

Getting Increlex (Mecasermin) Covered by Cigna in Washington: Prior Authorization, Appeals & Cost Savings

Answer Box: Getting Increlex (Mecasermin) Covered by Cigna in Washington Fastest Path to Approval: Cigna requires prior authorization for Increlex through a pediatric endocrinologist. Your child must be ≥2 years old with severe primary IGF-1 deficiency (height ≤-3.0 SD, IGF-1 below normal range). First step today: Contact your pediatric

How to Get Humira (adalimumab) Covered by Cigna in Washington: Complete PA Guide with Appeal Scripts

Answer Box: Getting Humira Covered by Cigna in Washington Eligibility: Cigna covers Humira (adalimumab) as a Tier 4 specialty medication with prior authorization required. Fastest path: Try biosimilar adalimumab alternatives first (Cyltezo, Simlandi) as required by step therapy. Start today: Have your rheumatologist submit the Accredo specialty pharmacy referral form

How to Get Trikafta Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered in Washington Trikafta requires prior authorization from Blue Cross Blue Shield plans in Washington (Premera, Regence). The fastest path: (1) Confirm your CFTR genotype documentation with F508del mutation, (2) Have your CF specialist submit PA with baseline labs and pulmonary function tests, (3) Ensure prescription

Myths vs. Facts: Getting Myozyme (Alglucosidase Alfa) Covered by UnitedHealthcare in Washington

Answer Box: Getting Myozyme Covered by UnitedHealthcare in Washington Eligibility: UnitedHealthcare requires prior authorization for Myozyme (alglucosidase alfa) with confirmed Pompe disease diagnosis via enzyme testing and genetic confirmation. Fastest path: Submit PA through UnitedHealthcare provider portal with comprehensive clinical documentation including specialist referral and diagnostic testing. First step today:

How to Get Palynziq (pegvaliase-pqpz) Covered by Cigna in Washington: Complete Guide with Forms and Appeal Scripts

Answer Box: To get Palynziq (pegvaliase-pqpz) covered by Cigna in Washington, you need: (1) PKU diagnosis with blood phenylalanine >600 µmol/L despite current management, (2) prescription from a metabolic specialist, and (3) prior authorization showing you're not using sapropterin concurrently. Submit via Cigna's provider

How to Get Pemazyre (Pemigatinib) Covered by Aetna CVS Health in Washington: Appeals, Forms & Timelines

Answer Box: Getting Pemazyre Covered by Aetna CVS Health in Washington Pemazyre (pemigatinib) requires prior authorization from Aetna CVS Health and is typically non-formulary, requiring a formulary exception. Key requirements: FDA-approved test confirming FGFR2 fusion/rearrangement, previous systemic therapy failure, and comprehensive clinical documentation. First step: Have your oncologist submit

Get Firdapse (Amifampridine) Covered by Cigna in Washington: Complete Prior Authorization Guide

Quick Answer: Getting Firdapse Covered by Cigna in Washington To get Firdapse (amifampridine) covered by Cigna in Washington, you need: (1) confirmed LEMS diagnosis with positive antibody testing or EMG, (2) prescription from a neurologist/neuromuscular specialist, (3) no seizure history, and (4) prior authorization submission. If denied, Washington'

How to Get Cometriq (Cabozantinib) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Cometriq Covered by UnitedHealthcare in Washington Fastest path to approval: Submit prior authorization through UnitedHealthcare's provider portal with complete medical records documenting medullary thyroid carcinoma diagnosis, progression status, and treatment history. If denied, pursue internal appeals (180 days) followed by Washington's Independent Review