Counterforce Health Team

How to Get Crysvita (burosumab) Covered by Blue Cross Blue Shield in Ohio: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Crysvita Covered in Ohio Blue Cross Blue Shield Ohio requires prior authorization for Crysvita (burosumab), with step therapy requiring failure of oral phosphate and vitamin D first. Coverage is restricted to FDA-approved uses (X-linked hypophosphatemia and tumor-induced osteomalacia) with specialist prescription. If denied, you have 180 days

How to Get Rinvoq (upadacitinib) Covered by Blue Cross Blue Shield in New York: Complete Guide to Forms, Appeals & Approval

Answer Box: Getting Rinvoq Covered by BCBS New York Blue Cross Blue Shield New York requires prior authorization for Rinvoq (upadacitinib), typically with step therapy requirements. Your fastest path to approval: (1) Have your doctor complete the BCBS PA form with detailed medical necessity documentation, (2) Submit through the Availity

Lowering Out-of-Pocket for Pemazyre (Pemigatinib) with UnitedHealthcare in New Jersey: Copay, Tiering & Assistance

Answer Box: Getting Pemazyre (Pemigatinib) Covered by UnitedHealthcare in New Jersey Pemazyre (pemigatinib) requires prior authorization from UnitedHealthcare and is placed on the specialty tier through OptumRx. Your first step is ensuring your oncologist has documented FGFR2 fusion/rearrangement (for cholangiocarcinoma) or FGFR1 rearrangement (for myeloid/lymphoid neoplasms) via molecular

How to Get Vitrakvi (Larotrectinib) Covered by UnitedHealthcare in Texas: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Vitrakvi Covered in Texas UnitedHealthcare requires prior authorization for Vitrakvi (larotrectinib) in Texas. For patients under 19, approval requires only age verification. Adults need documented NTRK gene fusion, metastatic/unresectable tumor, and no satisfactory alternatives. Submit the UnitedHealthcare PA form with molecular testing results through the provider

How to Get Cosentyx (Secukinumab) Covered by Humana in New York: Prior Authorization, Appeals, and Step Therapy Guide

Answer Box: Getting Cosentyx Covered by Humana in New York Cosentyx (secukinumab) requires prior authorization from Humana and typically sits on Tier 5 (Specialty) with step therapy requirements. Your fastest path to approval: Have your doctor submit a PA request with documented failure of preferred biologics, negative TB screening, and

Myths vs. Facts: Getting Turalio (pexidartinib) Covered by Humana in Michigan

Answer Box: Getting Turalio Covered by Humana in Michigan Yes, Humana covers Turalio (pexidartinib) for TGCT in Michigan, but prior authorization is required. The fastest path to approval: (1) Ensure your prescriber is REMS-certified and submits complete PA documentation including MRI confirming symptomatic TGCT not amenable to surgery, (2) Document

How to Get Orfadin (nitisinone) Covered by Blue Cross Blue Shield in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Orfadin Covered by Blue Cross Blue Shield in New Jersey Orfadin (nitisinone) requires prior authorization from Blue Cross Blue Shield in New Jersey. To get approved: (1) Confirm your HT-1 diagnosis with elevated succinylacetone levels and genetic testing, (2) Have your specialist submit a prior authorization request

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Aetna in Ohio: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Upstaza Covered by Aetna in Ohio Upstaza (eladocagene exuparvovec) requires prior authorization from Aetna in Ohio, with genetic confirmation of AADC deficiency and specialty pharmacy fulfillment. If denied, you have 180 days for internal appeals, then external review through Ohio Department of Insurance. Start with your prescriber

How to Get Tavalisse (Fostamatinib) Covered by Cigna in Texas: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Tavalisse Covered by Cigna in Texas Cigna covers Tavalisse (fostamatinib) for adults with chronic ITP after step therapy requirements are met. Your fastest path to approval: 1) Confirm you've tried required first-line treatments (steroids, IVIG, or TPO receptor agonists), 2) Have your hematologist submit a

How to Get Fabrazyme (Agalsidase Beta) Covered by Humana in New Jersey: Timeline, Appeals & Success Tips

Answer Box: Getting Fabrazyme Covered by Humana in New Jersey Humana requires prior authorization for Fabrazyme (agalsidase beta) under HCPCS code J0180. Standard processing takes up to 14 calendar days for complete requests, or 72 hours if expedited. In New Jersey, if denied, you have 65 days to appeal internally,