Topic

Washington

A collection of 489 issues

Blue Cross Blue Shield's Coverage Criteria for Zolgensma in Washington: What Counts as "Medically Necessary"?

Answer Box: Getting Zolgensma Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington require prior authorization for Zolgensma with strict medical necessity criteria: genetically confirmed SMA with bi-allelic SMN1 mutations, age under 2 years, anti-AAV9 antibody titer ≤1:50, and treatment at an approved

Get Fintepla (fenfluramine) Covered by Cigna in Washington: Complete Prior Authorization Guide with Appeals

Answer Box: Getting Fintepla Covered by Cigna in Washington Fintepla (fenfluramine) requires prior authorization from Cigna for Dravet syndrome or Lennox-Gastaut syndrome patients. Key requirements: confirmed diagnosis with ICD-10 codes G40.833/G40.834 (Dravet) or G40.81 (LGS), documented failure of standard anti-seizure medications, REMS enrollment, and baseline echocardiogram.

How Long Does It Take to Get Defitelio (Defibrotide) Approved by UnitedHealthcare in Washington? Complete Timeline Guide

Quick Answer: UnitedHealthcare typically processes Defitelio (defibrotide) prior authorization requests within 3-7 business days for standard review, or 24-72 hours for expedited cases involving hepatic VOD/SOS after HSCT. In Washington, if denied, you have 180 days to appeal internally, followed by external review through an Independent Review Organization (IRO)

Myths vs. Facts: Getting Duopa (Carbidopa/Levodopa Enteral) Covered by UnitedHealthcare in Washington

Answer Box: The Reality of UnitedHealthcare Duopa Coverage in Washington Myth: If your doctor prescribes Duopa, UnitedHealthcare automatically covers it. Fact: UHC requires prior authorization proving advanced Parkinson's disease with motor fluctuations that can't be managed by increasing oral levodopa, plus planned/completed PEG-J tube placement.

How to Get Soliris (Eculizumab) Covered by UnitedHealthcare in Washington: Complete Guide to Prior Authorization, Appeals, and State Resources

Quick Start: Your Path to Soliris Coverage in Washington Getting Soliris (eculizumab) covered by UnitedHealthcare in Washington requires prior authorization with strict documentation. First step: Verify your plan type (commercial, Medicaid/Apple Health, or Medicare) and gather diagnosis labs, vaccination records, and prior therapy history. Submit PA through the UnitedHealthcare

How to Get Tegsedi (Inotersen) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tegsedi (Inotersen) Approved by Cigna in Washington Cigna requires prior authorization for Tegsedi (inotersen) with strict criteria: confirmed hATTR polyneuropathy, TTR gene mutation, REMS enrollment, and detailed lab monitoring plan. In Washington, you have 72 hours for standard PA decisions and strong appeal rights including independent external

How to Get Mepsevii (vestronidase alfa-vjbk) Covered by Cigna in Washington: PA Forms, Appeals, and State Protections

Answer Box: Your Path to Mepsevii Coverage in Washington Cigna covers Mepsevii (vestronidase alfa-vjbk) for confirmed MPS VII but requires prior authorization. For Washington residents, strong state appeal protections make denials often overturnable. First step today: Have your metabolic specialist submit Cigna's Mepsevii CCRD PA form via CoverMyMeds

How to Get Ofev (nintedanib) Covered by Blue Cross Blue Shield in Washington: Forms, Appeals & Success Strategies

Answer Box: Getting Ofev Covered by Blue Cross Blue Shield in Washington Ofev (nintedanib) requires prior authorization from all Blue Cross Blue Shield plans in Washington (Premera, Regence, and FEP Blue). Success requires: (1) pulmonologist diagnosis of IPF or progressive fibrosing ILD, (2) HRCT showing fibrosis pattern, and (3) baseline

Get Myozyme (Alglucosidase Alfa) Covered by Aetna CVS Health in Washington: Complete PA Guide and Appeal Process

Answer Box: Your Fastest Path to Myozyme Coverage Myozyme (alglucosidase alfa) requires prior authorization from Aetna CVS Health, but is covered when medically necessary for confirmed Pompe disease. In Washington, submit your PA through CVS Specialty Pharmacy with GAA enzyme test results, genetic confirmation, and a specialist's medical

Getting Palynziq (pegvaliase-pqpz) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Palynziq Covered by Humana in Washington Humana Medicare Advantage plans require prior authorization for Palynziq (pegvaliase-pqpz), typically confirming blood phenylalanine levels >600 µmol/L, failed dietary therapy, and sapropterin trial. If denied, you have 65 days to appeal internally, followed by external review through Washington'