Counterforce Health Team

How to Get Cerezyme (Imiglucerase) Covered by Humana in Pennsylvania: Complete Coverage Guide

Answer Box: Your Path to Coverage Humana classifies Cerezyme (imiglucerase) as a nonpreferred drug requiring prior authorization and step therapy to preferred agents (Elelyso or Vpriv) first. To get coverage in Pennsylvania: (1) Submit PA request with Type 1 Gaucher disease diagnosis and step therapy documentation, (2) If denied, file

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Cigna in Pennsylvania: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Upstaza Covered by Cigna in Pennsylvania Cigna requires prior authorization for Upstaza (eladocagene exuparvovec) through Express Scripts/Accredo, with specific criteria including genetic confirmation of AADC deficiency and failed standard therapies. Submit via CoverMyMeds portal or call 800-753-2851 with genetic testing, severity assessment, and certified neurosurgical center

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

Answer Box: Getting Joenja Approved by BCBS in New Jersey Blue Cross Blue Shield plans in New Jersey typically require prior authorization for Joenja (leniolisib) with specific APDS diagnostic criteria. The fastest path involves: (1) confirming genetic APDS diagnosis with molecular testing, (2) submitting PA through your specialist with imaging

How to Get Elelyso (Taliglucerase Alfa) Covered by UnitedHealthcare in New Jersey: Complete Appeal Guide

Answer Box: Getting Elelyso Covered by UnitedHealthcare in New Jersey Elelyso (taliglucerase alfa) requires prior authorization from UnitedHealthcare and may not be on formulary, but you have strong appeal rights in New Jersey. Start with a peer-to-peer review within 24 hours of denial, then file a formal appeal through the

Myths vs. Facts: Getting Amvuttra (vutrisiran) Covered by Blue Cross Blue Shield in Ohio - Appeals, Forms & Timeline

Quick Answer: Blue Cross Blue Shield covers Amvuttra (vutrisiran) for hATTR polyneuropathy and ATTR cardiomyopathy when strict criteria are met, including documented PND score ≤ IIIb and genetic confirmation. Submit prior authorization via Availity Essentials with complete medical records. If denied, you have 180 days to file external review through the

Denied for Pyrukynd (Mitapivat) by Humana in Ohio? Complete Appeals Guide with Templates & Timelines

How to Get Pyrukynd (Mitapivat) Covered by Humana in Ohio For Humana Medicare Advantage members in Ohio denied Pyrukynd (mitapivat), you have 65 days to file an internal appeal and 180 days for external review through Ohio's Independent Review Organization. The fastest path: gather PKLR genetic testing (≥2

How to Get Voxzogo (Vosoritide) Covered by Cigna in Michigan: Forms, Appeals, and Approval Guide

Quick Answer: Cigna covers Voxzogo (vosoritide) for pediatric achondroplasia patients with confirmed FGFR3 mutations and open growth plates when prescribed by a pediatric endocrinologist or geneticist. Submit prior authorization via CoverMyMeds or EviCore portal with genetic testing, growth plate imaging, and specialist documentation. If denied, appeal within 180 days, then

Renewing Prolastin-C Coverage with Cigna in Pennsylvania: Complete 2025 Guide to Authorization, Appeals, and Timing

Answer Box: Fastest Path to Prolastin-C Renewal Cigna requires annual reauthorization for Prolastin-C in Pennsylvania. Start your renewal 60-90 days before expiration by gathering updated spirometry (within 6 months), recent clinical notes from your pulmonologist, and documentation of continued clinical benefit. Submit via your provider's Cigna portal or

How to Get Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Trikafta Covered by Aetna CVS Health in Illinois Aetna CVS Health requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) with specific genetic and clinical documentation. You'll need CFTR genotype confirmation, baseline liver tests, and CF specialist consultation. Submit through the Aetna provider portal or call

How to Get Gattex (Teduglutide) Covered by Aetna CVS Health in Ohio: PA Requirements, Appeals & Forms

Answer Box: Getting Gattex Covered by Aetna CVS Health in Ohio Aetna CVS Health covers Gattex (teduglutide) on specialty tiers with prior authorization required for short bowel syndrome patients dependent on parenteral nutrition ≥3 days weekly for ≥12 months. Submit PA via CVS Specialty at (866) 752-7021 with SBS diagnosis,