Topic

Washington

A collection of 233 issues

How to Get Haegarda (C1-Esterase Inhibitor) Covered by Aetna CVS Health in Washington: Complete Appeals Guide

Quick Answer: Getting Haegarda Covered by Aetna CVS Health in Washington To get Haegarda (C1-esterase inhibitor, SC) covered by Aetna CVS Health in Washington, you need prior authorization with specific documentation: confirmed HAE diagnosis with lab results (C1-INH levels below normal), specialist consultation, and proof you won't use

Getting Elzonris (Tagraxofusp-erzs) Covered by UnitedHealthcare in Washington: Complete PA Guide

Answer Box: Your Fastest Path to Coverage UnitedHealthcare requires prior authorization for Elzonris (tagraxofusp-erzs) and places it on specialty tier. To get approved in Washington: 1) Gather pathology confirming CD123+ BPDCN, recent labs, and clinical notes, 2) Submit PA through the UnitedHealthcare Provider Portal with complete documentation, 3) If denied,

How to Get Natpara (Parathyroid Hormone) Covered by Blue Cross Blue Shield in Washington: Appeals Guide with Forms and Deadlines

Quick Answer: Getting Natpara Covered by Blue Cross Blue Shield in Washington Important: Natpara is being discontinued globally, with U.S. shipments ending December 31, 2025. New patient approvals are extremely rare due to supply cessation. For existing patients or those seeking alternatives, here's your fastest path: 1.

Getting Xembify (Immune Globulin) Covered by Aetna in Washington: Complete Guide to Prior Authorization and Appeals

Quick Answer: Aetna requires prior authorization for Xembify in Washington. Start by having your doctor submit a Statement of Medical Necessity with your primary immunodeficiency diagnosis, infection history, and lab results. If denied, you can appeal internally and then request an external review through Washington's Office of Insurance

How Long Does It Take to Get Elelyso (taliglucerase alfa) Approved by Cigna in Washington? Complete Timeline Guide

Answer Box: Getting Elelyso Approved by Cigna in Washington Cigna typically decides on Elelyso (taliglucerase alfa) prior authorization requests within 1-3 business days when submitted electronically with complete documentation. Washington state requires insurers to respond within 3 calendar days for standard requests. Your fastest path: (1) Ensure your specialist has

How to Get Signifor / Signifor LAR (pasireotide) Approved by Cigna in Washington: Complete Timeline and Appeals Guide

Quick Answer: Getting Signifor Approved by Cigna in Washington Cigna requires prior authorization for Signifor/Signifor LAR (pasireotide) with 72-hour standard review times in Washington. Your endocrinologist must submit clinical documentation proving medical necessity, including biochemical evidence (elevated UFC for Cushing's or IGF-1 for acromegaly) and justification why

Renewing Carbaglu (Carglumic Acid) Coverage with Cigna in Washington: Complete Timeline and Documentation Guide

Answer Box: Renewing Carbaglu Coverage with Cigna in Washington Renewal Trigger: Start 2-4 weeks before your current authorization expires. Required Documentation: Updated plasma ammonia levels, weight documentation, and specialist letter confirming ongoing medical necessity for NAGS deficiency treatment. First Step: Contact Accredo at 877-826-7657 to check your renewal date and

How to Get Retevmo (Selpercatinib) Covered by Aetna in Washington: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Retevmo Covered by Aetna in Washington Aetna requires prior authorization for Retevmo (selpercatinib), with documentation of RET fusion testing and step therapy compliance. Most approvals take 72 hours with complete documentation. If denied, you have 60 days to appeal internally, then can request external review through Washington&

Coding That Helps Get Eloctate Covered by UnitedHealthcare in Washington (ICD-10, HCPCS/J-Code, NDC Guide)

Answer Box: Getting Eloctate Coded Correctly for UnitedHealthcare Coverage in Washington Quick Path to Approval: Use ICD-10 code D66 for hemophilia A, HCPCS J7205 for billing, and match the exact NDC to your vial strength. UnitedHealthcare requires prior authorization with hematologist prescription and stays within 40,250 units per 30-day

Emgality Approval with UnitedHealthcare in Washington: Complete Guide to Prior Authorization, Appeals, and Coverage

Answer Box: Getting Emgality Covered by UnitedHealthcare in Washington UnitedHealthcare covers Emgality (galcanezumab) in Washington with prior authorization. You'll need documentation of migraine diagnosis, at least 4 migraine days per month, and failed trials of 2+ preventive medications. Submit through the UnitedHealthcare Provider Portal with complete clinical records.