Topic

Washington

A collection of 233 issues

If Adynovate Isn't Approved by Aetna CVS Health in Washington: Formulary Alternatives & Exception Paths

Answer Box: Getting Adynovate Covered in Washington If Aetna CVS Health denies Adynovate (bdanocog alfa pegol) in Washington, you have three paths: 1) Try a preferred formulary alternative like Eloctate or Kovaltry first (fastest approval), 2) Request a formulary exception with documented medical necessity, or 3) Appeal the denial through

How to Get Vyondys 53 (Golodirsen) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Cigna requires prior authorization for Vyondys 53 (golodirsen) with genetic testing confirming exon 53-skippable DMD mutation, specialist prescription, baseline kidney function tests, and 6+ months of steroid stabilization. Submit through Express Scripts specialty pharmacy portal. If denied, Washington residents have 180 days for internal appeals, then external review

Work With Your Doctor to Get Keytruda (pembrolizumab) Approved by Blue Cross Blue Shield in Washington: Provider Collaboration Guide

Answer Box: Getting Keytruda Approved in Washington Keytruda (pembrolizumab) requires prior authorization from Blue Cross Blue Shield plans in Washington, including Premera and Regence. Your oncologist must submit clinical documentation proving medical necessity, including PD-L1 testing results for certain cancers and evidence of appropriate diagnosis staging. The fastest path: schedule

Get Rystiggo (Rozanolixizumab-noli) Covered by Aetna in Washington: Coding, Appeals & IRO Guide

Answer Box: Quick Path to Rystiggo Coverage To get Rystiggo (rozanolixizumab-noli) covered by Aetna in Washington, you need proper coding and documentation. Use ICD-10 G70.00 or G70.01 for myasthenia gravis, J-code J9333 for billing, and ensure antibody test results (AChR+ or MuSK+) are documented. If denied, Washington offers

How to Get Fabrazyme (Agalsidase Beta) Covered by Blue Cross Blue Shield in Washington: Complete PA Guide

Quick Answer: Getting Fabrazyme Covered by Blue Cross Blue Shield in Washington Fabrazyme (agalsidase beta) requires prior authorization from Blue Cross Blue Shield in Washington and is typically covered as a specialty medication when medical necessity criteria are met. The fastest path to approval: (1) Ensure genetic or biochemical confirmation

Opfolda (Miglustat) Approval with UnitedHealthcare in Washington: Complete Guide to Coverage, Appeals, and Patient Support

Quick Answer: Getting Opfolda Covered by UnitedHealthcare in Washington Opfolda (miglustat) requires prior authorization from UnitedHealthcare and must be prescribed with Pombiliti for late-onset Pompe disease in adults ≥40 kg who aren't improving on current enzyme replacement therapy. Start by having your provider submit a PA request through

Renewing Opzelura (Ruxolitinib Cream) Approval with Aetna CVS Health in Washington: Complete Timeline and Documentation Guide

Answer Box: Renewing Opzelura with Aetna CVS Health in Washington Aetna CVS Health typically approves Opzelura (ruxolitinib cream) renewals for 12 months when you document clinical response and confirm no concurrent use of biologics or other JAK inhibitors. Start renewal 2-4 weeks before expiration to avoid treatment gaps. Required: evidence

How to Get Abecma (idecabtagene vicleucel) Covered by Aetna CVS Health in Washington: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Abecma Covered by Aetna CVS Health in Washington Abecma requires prior authorization from Aetna CVS Health in Washington. You need documentation of relapsed/refractory multiple myeloma with at least two prior lines of therapy including an immunomodulatory agent, proteasome inhibitor, and anti-CD38 antibody. Call Aetna National Medical

How Long Does It Take to Get Increlex (mecasermin) Approved by Blue Cross Blue Shield in Washington? Timeline & Milestones

Quick Answer: Increlex (mecasermin) Approval Timeline in Washington Standard approval timeline: 3-14 business days for complete Blue Cross Blue Shield prior authorization submissions in Washington. Expedited review: 24-72 hours for urgent cases where delay could jeopardize patient health. Key factors affecting timing: completeness of IGF-1 deficiency documentation, bone age studies,

How to Get Translarna (Ataluren) Covered by Aetna CVS Health in Washington: Complete Appeals Guide with Forms and Timelines

Quick Answer: Translarna (ataluren) is typically excluded from Aetna's standard formularies, requiring a formulary exception request with detailed genetic testing documentation and clinical justification. In Washington, you have 60 days to file internal appeals and can request external review through the state's Independent Review Organization (IRO)