Topic

Washington

A collection of 489 issues

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

Answer Box: Getting Tegsedi (inotersen) Covered by Aetna (CVS Health) in Washington Aetna (CVS Health) requires prior authorization for Tegsedi (inotersen) with specific documentation: TTR gene mutation testing, specialist prescription, and FDA REMS enrollment. Submit via Availity portal or fax (866-752-7021) at least 2 weeks before treatment. If denied, Washington

How to Get Juxtapid (Lomitapide) Covered by UnitedHealthcare in Washington: Complete Coverage Guide with Forms and Appeals

Answer Box: UnitedHealthcare requires prior authorization for Juxtapid (lomitapide) in Washington with strict criteria: confirmed HoFH diagnosis (genetic testing or untreated LDL-C >400 mg/dL plus clinical markers), documented failure of both Repatha and Evkeeza, REMS-certified specialist prescriber, and baseline liver function tests. Submit via OptumRx portal with genetic

How to Get Gilenya (Fingolimod) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Guide and Appeals Process

Answer Box: Getting Gilenya Covered in Washington Gilenya (fingolimod) requires prior authorization from Blue Cross Blue Shield plans in Washington. To get approved, you'll need baseline testing (EKG, eye exam, labs), documentation of MS diagnosis, and often proof that you've tried other therapies first. If denied,

Coding That Helps Get Elelyso (Taliglucerase Alfa) Approved in Washington with UnitedHealthcare: ICD-10, HCPCS J-Code, and Billing Guide

Answer Box: Fast Track to Elelyso Coverage Getting Elelyso (taliglucerase alfa) covered by UnitedHealthcare in Washington requires precise coding and documentation. Use ICD-10 code E75.22 for Gaucher disease, HCPCS J-code J3060 for billing (10 units per code), and calculate total dose ÷ 10 for billable units. Submit prior authorization through

How to Get Rebif (Interferon Beta-1a) Covered by Cigna in Washington: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Rebif Covered by Cigna in Washington Rebif (interferon beta-1a) requires prior authorization from Cigna, typically managed through Express Scripts/Accredo specialty pharmacy. The fastest path to approval: 1) Ensure your neurologist documents relapsing MS with proper ICD-10 codes (G35.A for RRMS, G35.C1 for active SPMS)

How to Get Thiola / Thiola EC (Tiopronin) Covered by Blue Cross Blue Shield in Washington: Complete Appeals Guide with Forms and Timelines

Answer Box: Fastest Path to Thiola Coverage Blue Cross Blue Shield plans in Washington typically require prior authorization for Thiola/Thiola EC (tiopronin). To get coverage, you'll need: confirmed cystinuria diagnosis (24-hour urine cystine >300 mg/day), documented failure of alkalinization therapy for at least 3 months,

Work With Your Doctor to Get Juxtapid (lomitapide) Approved by Aetna (CVS Health) in Washington

Answer Box: Getting Juxtapid (lomitapide) Covered by Aetna (CVS Health) in Washington Success requires strong provider partnership and complete documentation. Aetna typically requires genetic confirmation of homozygous familial hypercholesterolemia (HoFH), evidence of failed high-intensity statin plus ezetimibe therapy, baseline liver function tests, and REMS program enrollment. First step today: Schedule

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

Answer Box: Getting Cerezyme (Imiglucerase) Covered by Cigna in Washington Fastest Path to Approval: Submit Cigna's Cerezyme/Elelyso/VPRIV prior authorization form with documented Gaucher disease (enzyme assay or genetic testing), prescription from a metabolic/lysosomal storage disorder specialist, and clinical notes showing symptoms. No step therapy required.

How to Get Rinvoq (upadacitinib) Covered by Blue Cross Blue Shield in Washington: Forms, Appeals, and Success Strategies

Quick Answer: Getting Rinvoq Covered by Blue Cross Blue Shield in Washington Rinvoq (upadacitinib) requires prior authorization from Blue Cross Blue Shield plans in Washington, with most plans mandating documented failure of TNF inhibitors first. Submit through the Availity portal (fastest: 1-3 days) or fax using Premera's pharmacy

How to Get Ibrance (Palbociclib) Covered by Aetna (CVS Health) in Washington: Prior Authorization, Appeals, and Formulary Alternatives Guide

Answer Box: Getting Ibrance (Palbociclib) Approved by Aetna (CVS Health) in Washington Ibrance (palbociclib) requires prior authorization from Aetna (CVS Health) for HR+/HER2- metastatic breast cancer. Submit PA via provider portal or fax with pathology confirming HR+/HER2- status, prior endocrine therapy documentation, and prescriber attestation. Standard decisions take