Counterforce Health Team

How to Get Oxervate (Cenegermin) Covered by Humana in New York: Appeals, Forms, and Financial Assistance

Answer Box: Getting Oxervate Covered by Humana in New York Quick Path to Approval: Oxervate (cenegermin) requires prior authorization from Humana and is typically non-formulary or specialty tier. Success depends on documenting stage 2/3 neurotrophic keratitis diagnosis, failed conventional treatments, and corneal nerve damage evidence. If denied, New York

Do You Qualify for Fintepla (Fenfluramine) Coverage by Aetna (CVS Health) in California? Decision Tree & Next Steps

Answer Box: Quick Qualification Check To qualify for Fintepla (fenfluramine) coverage by Aetna (CVS Health) in California: You need a confirmed diagnosis of Dravet syndrome or Lennox-Gastaut syndrome (LGS) from a neurologist, documented failure of at least two standard antiseizure medications, enrollment in the FDA REMS program with baseline echocardiogram,

How to Get Cosentyx (Secukinumab) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Appeals Guide

Answer Box: Getting Cosentyx Covered by Blue Cross Blue Shield in Pennsylvania Cosentyx (secukinumab) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania, with step therapy requirements effective January 2025. The fastest path to approval: (1) Document failed trials with preferred agents like methotrexate or TNF inhibitors,

How to Get Spinraza (nusinersen) Covered by UnitedHealthcare in North Carolina: Renewal Guide, Appeals, and Timeline

Answer Box: Renewing Spinraza Coverage with UnitedHealthcare in North Carolina UnitedHealthcare requires annual prior authorization renewal for Spinraza (nusinersen), limited to 3 maintenance doses per 12 months. Submit renewal requests 30-60 days before your current authorization expires. Required documentation includes updated motor function assessments (HFMSE or RULM scores showing ≥3-point

Getting Aldurazyme (laronidase) Covered by Humana in California: Complete Prior Authorization Guide

Answer Box: Quick Path to Coverage Getting Aldurazyme (laronidase) covered by Humana in California requires prior authorization with documented MPS I diagnosis. Your fastest path: (1) Ensure you have confirmed enzymatic and genetic testing results showing MPS I, (2) Have your prescriber submit a comprehensive prior authorization request through Humana&

How to Get Strimvelis Gene Therapy Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Strimvelis Covered by UnitedHealthcare in Washington Strimvelis gene therapy for ADA-SCID requires prior authorization from UnitedHealthcare through OptumRx, with extensive documentation of genetic diagnosis (ICD-10 D81.31), failed standard therapies, and specialist support. Since Strimvelis isn't FDA-approved and is only available in Milan, Italy, you&

How to Get Trikafta Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide 2024

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Virginia Trikafta requires prior authorization from Aetna CVS Health in Virginia. Submit complete documentation including CFTR genotype testing showing F508del mutation, CF diagnosis with ICD-10 codes E84.0-E84.9, and baseline liver function tests. If denied, appeal within 180 days

How to Get Berinert (C1-esterase inhibitor, IV) Covered by Blue Cross Blue Shield in New Jersey: Complete Approval Guide

Answer Box: Getting Berinert Covered in New Jersey Berinert (C1-esterase inhibitor, IV) requires prior authorization from Blue Cross Blue Shield in New Jersey. Success depends on proper HAE diagnosis documentation, attack history, and clinical justification for 20 units/kg dosing per FDA labeling. Fastest path to approval: 1. Gather HAE

Getting Zanzalintinib (XL092) Covered by Cigna in Texas: Complete Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Zanzalintinib (XL092) Covered by Cigna in Texas Zanzalintinib (XL092) is investigational and typically denied by Cigna, but coverage is possible through prior authorization and appeals. Start with your oncologist submitting a detailed PA request using ICD-10 codes specific to your cancer type and HCPCS code J3490. If

Renewing Opsumit (Macitentan) Approval with UnitedHealthcare in North Carolina: 2025 Requirements & Timeline

Answer Box: Opsumit (macitentan) renewal with UnitedHealthcare in North Carolina requires submitting updated clinical documentation 30-60 days before your current authorization expires. Key 2025 changes: OptumRx is eliminating many chronic disease reauthorizations, but Opsumit's status must be verified through your provider portal. If still required, submit WHO functional