Topic

Washington

A collection of 489 issues

Work With Your Doctor to Get Epidiolex (Cannabidiol) Covered by Cigna in Washington: Complete Provider Collaboration Guide

Answer Box: Getting Cigna to Cover Epidiolex in Washington To get Epidiolex (cannabidiol) covered by Cigna in Washington, you need prior authorization with documented diagnosis of Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex, plus evidence of failed alternative seizure medications. Your neurologist must complete Cigna's PA form

How to Get Berinert (C1-esterase inhibitor, IV) Covered by Humana in Washington: Complete Prior Authorization Guide

Answer Box: Getting Berinert Covered by Humana in Washington Humana requires prior authorization for Berinert (C1-esterase inhibitor, IV) for hereditary angioedema treatment. The fastest path to approval: (1) Submit PA request through CoverMyMeds with complete HAE diagnosis documentation, (2) Include evidence of failed alternative therapies or contraindications, and (3) Use

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

Answer Box: Your Fastest Path to Pemazyre Coverage Yes, you can get Pemazyre (pemigatinib) covered by Cigna in Washington if you have unresectable/metastatic cholangiocarcinoma with FGFR2 fusion/rearrangement and prior systemic therapy. The fastest path: 1) Confirm FGFR2 testing is complete, 2) Submit Cigna's prior authorization with

How to Get Elelyso (Taliglucerase Alfa) Covered by Humana in Washington: Complete Guide with Appeals Process

Quick Answer: Getting Elelyso Covered by Humana in Washington Elelyso (taliglucerase alfa) requires prior authorization from Humana. You'll need: confirmed Type 1 Gaucher disease diagnosis (enzyme deficiency + genetic testing), specialist prescriber (hematologist/endocrinologist), and clinical documentation showing medical necessity. If denied, Washington offers strong appeal rights including binding

How to Get Onivyde (Irinotecan Liposome) Covered by Humana in Washington: Prior Authorization, Appeals & Network Requirements

Answer Box: Getting Onivyde Covered by Humana in Washington Humana covers Onivyde (irinotecan liposome) in Washington, but requires prior authorization (PA) for all regimens. The NALIRIFOX combination (Onivyde + oxaliplatin + 5-FU + leucovorin) is FDA-approved for first-line metastatic pancreatic cancer as of February 2024. Fastest path to approval: 1. Submit PA request

How to Get Galafold (migalastat) Covered by Cigna in Washington: Alternative Treatments and Appeal Options

Answer Box: Galafold (migalastat) Coverage by Cigna in Washington Getting Galafold covered by Cigna requires genetic confirmation of an amenable GLA variant plus prior authorization. If denied, you have strong appeal rights in Washington, including external review through an Independent Review Organization (IRO). Your 3-step path: 1. Confirm eligibility: Genetic

How to Get Kuvan (Sapropterin) Covered by Cigna in Washington: Appeals, Alternatives & Success Strategies

Answer Box: Getting Kuvan Covered by Cigna in Washington Cigna requires prior authorization for Kuvan (sapropterin dihydrochloride) for PKU treatment. Your fastest path to approval: (1) Have your metabolic specialist submit a PA request through Cigna's provider portal with documented PKU diagnosis, BH4 responsiveness testing showing ≥30% phenylalanine

Work With Your Doctor to Get Strensiq (asfotase alfa) Covered by Cigna in Washington: Forms, Appeals, and Success Strategies

Answer Box: To get Strensiq (asfotase alfa) covered by Cigna in Washington, you need confirmed pediatric-onset hypophosphatasia diagnosis with genetic testing, low alkaline phosphatase levels, and specialist prescription. Start by gathering your medical records, lab results, and genetic testing reports. Your doctor must submit a prior authorization with detailed clinical

How to Get Mycapssa (Octreotide Oral) Covered by Humana in Washington: Complete Prior Authorization Guide

Answer Box: Getting Mycapssa Covered by Humana in Washington Mycapssa (oral octreotide) requires prior authorization from Humana and typically needs documentation of prior response to injectable octreotide or lanreotide for acromegaly. Here's the fastest path: 1. Gather documentation: Confirmed acromegaly diagnosis (elevated IGF-1), prior injectable SSA therapy records,

Getting Soliris (Eculizumab) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Quick Start: Getting Soliris Covered by Humana in Washington Soliris (eculizumab) requires prior authorization from Humana in Washington and is covered under the medical benefit (Part B/Medicare Advantage), not pharmacy benefit. The fastest path to approval: (1) Ensure meningococcal vaccination is current and documented, (2) Have your provider submit