Topic

Washington

A collection of 489 issues

How to Get Daybue (trofinetide) Covered by Aetna (CVS Health) in Washington: Complete PA Guide, Forms, and Appeal Process

Answer Box: Aetna (CVS Health) requires prior authorization for Daybue (trofinetide) with genetic confirmation of Rett syndrome (MECP2 mutation), specialist prescription, and age ≥2 years. Submit PA through Aetna provider portal with MECP2 test results, neurologist notes, and weight-based dosing calculation. If denied, Washington offers external review through Independent Review

How to Get Hetlioz (Tasimelteon) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Forms, Appeals, and Alternative Options

Answer Box: Getting Hetlioz (Tasimelteon) Approved by Blue Cross Blue Shield in Washington Blue Cross Blue Shield in Washington (Premera Blue Cross, Regence BlueShield) covers Hetlioz (tasimelteon) as a non-preferred specialty medication requiring prior authorization for Non-24-hour sleep-wake disorder and Smith-Magenis syndrome. Success requires: (1) Failed trials of melatonin or

Work With Your Doctor to Get Jaypirca (Pirtobrutinib) Approved by UnitedHealthcare in Washington: Provider Partnership Guide

Answer Box: Your Path to Jaypirca Coverage To get Jaypirca (pirtobrutinib) approved by UnitedHealthcare in Washington, you'll need prior authorization through OptumRx with documented BTK inhibitor failure. Your oncologist must submit evidence of prior treatment with drugs like ibrutinib or acalabrutinib, plus clinical rationale for why Jaypirca is

How to Get Hemlibra (emicizumab-kxwh) Covered by Humana in Washington: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Hemlibra Covered by Humana in Washington Hemlibra (emicizumab-kxwh) requires prior authorization from Humana for hemophilia A patients in Washington. Submit documentation including confirmed diagnosis (ICD-10 D66), FVIII activity <5%, inhibitor testing, and bleeding history through Humana's provider portal or by fax to 877-486-2621. If

How to Get Somatuline Depot (Lanreotide) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Blue Cross Blue Shield plans in Washington (primarily Premera Blue Cross) require prior authorization for Somatuline Depot (lanreotide), typically demanding an octreotide trial first. Submit PA with specialist documentation, FDA-approved diagnosis (acromegaly, GEP-NETs, carcinoid syndrome), and clinical failure evidence. If denied, appeal within 180 days internally, then request

How to Get Alprolix (Coagulation Factor IX) Covered by Cigna in Washington: Complete PA Guide with Appeal Timeline

Answer Box: Quick Path to Approval Cigna requires prior authorization for Alprolix (eftrenonacog alfa) in Washington. Submit the Clotting Factors Prior Authorization Form with hematologist documentation, factor IX levels, and bleeding history. Route through Accredo specialty pharmacy. Standard review takes 5 business days; expedited (24 hours) for urgent cases. If

Getting Ozempic and Mounjaro Covered by UnitedHealthcare in Washington: 2025 Prior Authorization Guide

Answer Box: Quick Path to Coverage UnitedHealthcare requires prior authorization for Ozempic (semaglutide) and Mounjaro (tirzepatide) in Washington, approved for 12 months when prescribed for type 2 diabetes. Submit through the UHC Provider Portal with A1C ≥6.5% documentation or diabetes medical records. If denied, use Washington's robust

How to Get Hemgenix (etranacogene dezaparvovec) Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hemgenix Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Hemgenix (etranacogene dezaparvovec) in Washington but does not mandate step therapy with alternative therapies. To get approval: 1) Verify eligibility (age 18+, severe hemophilia B, 50+ factor IX exposure days, negative inhibitors), 2) Submit PA through

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Humana in Washington: Prior Authorization Guide and Appeal Process

Answer Box: Getting Upstaza Covered by Humana in Washington Upstaza (eladocagene exuparvovec) requires prior authorization from Humana and must be administered at a certified neurosurgical center. For Washington residents, the fastest path involves: 1) Confirming AADC deficiency diagnosis with genetic testing and CSF biomarkers, 2) Submitting prior authorization through Humana&

How to Get Keytruda (Pembrolizumab) Covered by Aetna (CVS Health) in Washington: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Keytruda Covered by Aetna in Washington Aetna (CVS Health) requires prior authorization for Keytruda (pembrolizumab) with biomarker documentation (PD-L1 CPS ≥1, MSI-H, or TMB-H ≥10). Submit via fax to 1-888-267-3277 with clinical notes, pathology, and prior therapy records. If denied, appeal within 180 days; Washington offers external