Topic

Washington

A collection of 489 issues

Myths vs. Facts: Getting Raxone (Idebenone) Covered by Cigna in Washington

Quick Answer: Raxone (idebenone) is not FDA-approved in the US, making Cigna coverage extremely limited and typically requiring compassionate use documentation or formulary exception requests. In Washington, patients have strong appeal rights through internal reviews and binding external IRO reviews. First step: Request written denial reasons from Cigna, then gather

UnitedHealthcare's Coverage Criteria for Keytruda in Washington: What Counts as "Medically Necessary"?

Answer Box: Getting Keytruda Covered by UnitedHealthcare in Washington To get Keytruda (pembrolizumab) covered by UnitedHealthcare in Washington, you need prior authorization with specific biomarker testing results (PD-L1 CPS ≥1, MSI-H, or TMB-H ≥10 mutations/megabase for most indications). Submit through the UnitedHealthcare Provider Portal with complete pathology reports, clinical

Get Cystadane (Betaine Anhydrous) Covered by Humana in Washington: Provider Collaboration Guide with Appeals Process

Quick Answer: Getting Cystadane Covered by Humana in Washington Cystadane (betaine anhydrous) requires prior authorization from Humana for homocystinuria treatment. Success depends on strong provider partnership: confirmed genetic/biochemical diagnosis, documented vitamin therapy failures, and specialist oversight. First step: Schedule a visit to review your complete treatment history and gather

How to Get Gilenya (Fingolimod) Covered by Aetna CVS Health in Washington: 2025 Prior Authorization Guide

Answer Box: Quick Path to Coverage Aetna CVS Health requires prior authorization for Gilenya (fingolimod) in Washington, with mandatory step therapy through generic fingolimod first. Your neurologist must document relapsing MS diagnosis, submit baseline EKG and monitoring plan, and provide evidence of generic failure/intolerance for brand approval. If denied,

Lowering Out-of-Pocket Costs for Zokinvy (lonafarnib) with Blue Cross Blue Shield in Washington: Copay Cards, Tiering Exceptions & Financial Assistance

Answer Box: Getting Zokinvy Covered at Lower Cost For Washington residents with Blue Cross Blue Shield: Zokinvy (lonafarnib) is typically placed on specialty tiers with high cost-sharing. To reduce out-of-pocket costs: 1) Apply for the Sentynl Cares copay assistance program if you have commercial insurance, 2) Request a formulary tier

How to Get Ilaris (Canakinumab) Covered by Blue Cross Blue Shield in Washington: Complete Guide to Prior Authorization and Appeals

Answer Box: Fast Track to Approval Getting Ilaris (canakinumab) covered by Blue Cross Blue Shield in Washington requires prior authorization with specific documentation. Here's the fastest path: 1. Gather diagnostic evidence: Yamaguchi criteria for AOSD or ILAR criteria for SJIA, plus elevated inflammatory markers (ESR, CRP, ferritin >

Renewing Voxzogo (Vosoritide) Approval with UnitedHealthcare in Washington: 2025 Requirements & Timeline

Quick Answer: Voxzogo Renewal Requirements UnitedHealthcare requires annual reauthorization for Voxzogo (vosoritide) with documented clinical response and open epiphyses. Start renewal 60 days before expiration. Key documents: updated growth data showing improved velocity, bone age confirmation of open growth plates, and provider attestation of continued benefit. Submit through OptumRx provider

How to Get Arikayce Covered by Humana in Washington: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Arikayce Covered by Humana in Washington Arikayce (amikacin liposome inhalation) requires prior authorization from Humana and is typically approved only for refractory MAC lung disease after 6+ months of failed standard therapy. In Washington, if denied, you have 60 days to request external review through an Independent

How to Get Entresto (sacubitril/valsartan) Covered by Humana in Washington: Appeals Guide & Templates

Quick Answer: Getting Entresto Covered by Humana in Washington Entresto requires prior authorization from Humana and is typically covered as a Tier 3 medication. If denied, you have 65 days to appeal. The fastest path: 1) Have your cardiologist submit a medical necessity letter documenting your heart failure diagnosis with

How Long Does It Take to Get Rylaze Approved by Blue Cross Blue Shield in Washington? Complete Timeline & Appeal Guide

Answer Box: Rylaze Approval Timeline in Washington Blue Cross Blue Shield Washington typically processes Rylaze prior authorization in 72 hours for urgent cases and 5-7 business days for standard requests. You'll need documented hypersensitivity to E. coli asparaginase, ALL/LBL diagnosis, and oncologist prescription. If denied, internal appeals