Counterforce Health Team

How to Get Tysabri (natalizumab) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tysabri Covered by Aetna CVS Health in North Carolina Tysabri (natalizumab) requires prior authorization from Aetna CVS Health with mandatory TOUCH Prescribing Program enrollment, recent JCV antibody testing, and brain MRI documentation. Submit requests via phone (1-855-582-2025), fax (1-855-330-1716), or mail with complete medical records. If denied,

Getting Tagrisso (Osimertinib) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tagrisso Covered by BCBS North Carolina Fastest Path: Tagrisso (osimertinib) requires prior authorization from Blue Cross Blue Shield of North Carolina for EGFR-mutant NSCLC. Your oncologist must document EGFR mutation testing (exon 19 deletion or L858R), disease staging, and any prior TKI failures. Submit PA via CoverMyMeds

How to Get Uptravi (Selexipag) Covered by Humana in Ohio: Prior Authorization Guide with Appeals Process

Quick Answer: Getting Uptravi (Selexipag) Covered by Humana in Ohio Your fastest path to approval: Submit a prior authorization request with documented WHO Group I PAH diagnosis, functional class II-IV status, 6-minute walk test results, and evidence of background therapy plan. If denied, you have 65 days to appeal with

How to Get Therakos CELLEX Photopheresis Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Therakos CELLEX Covered in North Carolina Blue Cross Blue Shield of North Carolina covers Therakos CELLEX photopheresis for FDA-approved uses like cutaneous T-cell lymphoma (CTCL) and steroid-refractory graft-versus-host disease (GVHD), but requires prior authorization. Your doctor submits a PA request through the BCBS NC provider portal with

How to Get Evkeeza (evinacumab-dgnb) Covered by UnitedHealthcare in Washington: Complete Prior Authorization Guide

Quick Answer: Getting Evkeeza Covered in Washington Evkeeza (evinacumab-dgnb) requires prior authorization from UnitedHealthcare OptumRx with no step therapy requirements for homozygous familial hypercholesterolemia (HoFH). Submit PA documentation including HoFH diagnosis (genetic confirmation or clinical phenotype), maximally tolerated lipid-lowering therapy failures, and specialist prescription. If denied, Washington's robust

How to Get Kesimpta (Ofatumumab) Covered by Blue Cross Blue Shield in California: Prior Authorization, Appeals & Cost Savings

Answer Box: Getting Kesimpta Covered by Blue Shield of California Kesimpta (ofatumumab) requires prior authorization from Blue Shield of California for relapsing multiple sclerosis. The fastest path to approval: 1) Submit PA request with MS diagnosis (ICD-10: G35) and documentation of failed/contraindicated alternatives like Betaseron or Copaxone, 2) Obtain

How to Get Defitelio (Defibrotide) Covered by Aetna CVS Health in Illinois: Complete Guide with Forms and Appeals

Answer Box: Getting Defitelio Covered by Aetna in Illinois Defitelio (defibrotide) requires prior authorization from Aetna CVS Health for severe hepatic veno-occlusive disease (VOD/SOS) with organ dysfunction post-HSCT. Submit PA through Aetna provider portal with complete transplant records, organ dysfunction evidence, and FDA indication match. If denied, file internal

How to Get Prolastin-C (Alpha1-Proteinase Inhibitor) Covered by Aetna CVS Health in Michigan: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Prolastin-C Covered by Aetna CVS Health in Michigan Prolastin-C requires prior authorization from Aetna CVS Health with specific coding and documentation. Use ICD-10 code E88.01 (alpha-1 antitrypsin deficiency) with J43.9 (emphysema), HCPCS code J0256 (10mg units), and NDC 13533-0700-xx series. Submit PA forms to 888-267-3277

How to Get Naglazyme (Galsulfase) Covered by Cigna in Virginia: Complete Coding, Prior Authorization, and Appeals Guide

Quick Answer: Getting Naglazyme Covered by Cigna in Virginia Naglazyme (galsulfase) requires Cigna prior authorization with confirmed MPS VI diagnosis (ICD-10 E76.29), specialist prescription, and functional assessments. Submit using HCPCS J1458 (1 mg = 1 unit), include enzyme assay results and baseline 6-minute walk test. If denied, file internal appeal

How to Get Rystiggo (rozanolixizumab-noli) Covered by UnitedHealthcare in Washington: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Rystiggo Covered by UnitedHealthcare in Washington Rystiggo (rozanolixizumab-noli) requires prior authorization from UnitedHealthcare and must be dispensed through their specialty pharmacy network. To get coverage in Washington: (1) Your neurologist submits a PA request with antibody test results (AChR or MuSK positive) and documented failure or intolerance