Topic

Washington

A collection of 233 issues

How to Get Ocrevus (Ocrelizumab) Covered by Humana in Washington: Forms, Appeals, and Support Resources

Answer Box: Getting Ocrevus Covered by Humana in Washington Ocrevus (ocrelizumab) requires prior authorization from Humana in Washington and may be subject to step therapy requirements. The fastest path to approval: (1) Have your neurologist submit a complete PA request through Humana's Availity portal with detailed MS diagnosis

How to Get Berinert (C1-Esterase Inhibitor) Covered by Cigna in Washington: Appeals Guide with Forms and Timelines

Quick Answer: Getting Berinert Covered by Cigna in Washington Berinert requires prior authorization from Cigna for all uses. The fastest path to approval: 1) Have your allergist/immunologist submit a PA request with documented HAE type I/II diagnosis, prior treatment history, and weight-based dosing rationale. 2) If denied, file

How to Get Tremfya (guselkumab) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Forms, Appeals, and Coding Guide

Quick Answer: Getting Tremfya Covered by Blue Cross Blue Shield in Washington Yes, Tremfya (guselkumab) can be covered by Blue Cross Blue Shield plans in Washington, but prior authorization is required. Most plans require step therapy with TNF inhibitors first, tuberculosis screening, and documentation of moderate-to-severe disease. If denied, Washington&

Lowering Out-of-Pocket for Luxturna with UnitedHealthcare in Washington: Copay, Tiering & Assistance Programs

Quick Answer: Getting Luxturna Covered by UnitedHealthcare in Washington Luxturna requires prior authorization from UnitedHealthcare and is placed on the specialty (highest) formulary tier. Your out-of-pocket costs depend on your plan's specialty tier design, but manufacturer assistance can reduce costs to zero for eligible commercial insurance patients. First

How to Get Dojolvi (Triheptanoin) Covered by Aetna CVS Health in Washington: Complete Coding, Prior Auth & Appeals Guide

Answer Box: Getting Dojolvi Covered by Aetna CVS Health in Washington Fastest path to approval: Submit a specialty drug prior authorization request with molecular LC-FAOD confirmation (ICD-10 E71.318), discontinuation of MCT products, and metabolic specialist oversight. Use HCPCS J8499 with correct NDC for billing. If denied, Washington residents have

Get Xenpozyme (Olipudase Alfa) Covered by Humana in Washington: Complete Decision Tree & Appeal Guide

Answer Box: Your Fastest Path to Approval If you have confirmed ASMD (Niemann-Pick Type B or A/B) and meet Humana's criteria, expect 1-30 days for prior authorization approval. Your first step today: Have your doctor submit a prior authorization request through Humana's provider portal with

How to Get Onivyde (Irinotecan Liposome) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Guide and Appeals Process

Answer Box: Getting Onivyde Covered in Washington Blue Cross Blue Shield in Washington requires prior authorization for Onivyde (irinotecan liposome), typically covering it for metastatic pancreatic cancer when used in combination regimens like NALIRIFOX. Key requirements include ECOG performance status 0-1, documented diagnosis, and detailed clinical justification. If denied, you

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

Quick Answer: Defitelio (defibrotide) requires prior authorization from Aetna CVS Health for FDA-approved hepatic VOD/SOS treatment post-HSCT. Submit clinical documentation showing VOD diagnosis plus renal/pulmonary dysfunction through CVS Specialty Pharmacy. If denied, use Washington's external review process within 180 days. Start by gathering transplant records, diagnosis

UnitedHealthcare's Coverage Criteria for Upstaza (Eladocagene Exuparvovec) in Washington: What Counts as "Medically Necessary"?

Answer Box: UnitedHealthcare requires prior authorization for Upstaza (eladocagene exuparvovec) gene therapy, demanding genetic confirmation of DDC mutations, biochemical proof of AADC deficiency, and administration at a certified gene therapy center. If denied, Washington residents can appeal through internal review, then request external review through an Independent Review Organization (IRO)

How to Get Busulfex (busulfan injection) Covered by Humana in Washington: Appeals Process, Forms, and State Protections

Answer Box: Getting Busulfex Covered by Humana in Washington Busulfex (busulfan injection, J0594) requires prior authorization from Humana and may be subject to step therapy requirements for bone marrow transplant conditioning. In Washington, you have strong state protections including medical exceptions to step therapy and external review through Independent Review