Counterforce Health Team

The Requirements Checklist to Get Entresto (Sacubitril/Valsartan) Covered by Aetna (CVS Health) in Washington

Quick Answer: Getting Entresto Approved Entresto requires prior authorization from Aetna (CVS Health) for heart failure patients with LVEF ≤40%. To get approved in Washington: 1) Gather recent echocardiogram showing reduced ejection fraction, 2) Document ACE inhibitor or ARB trial failure, 3) Submit via Aetna provider portal. If denied, you

How to Get iLink® Corneal Cross-Linking Covered by Cigna in Washington: Complete Prior Authorization Guide

Answer Box: Getting iLink® Covered by Cigna in Washington To get iLink® corneal cross-linking covered by Cigna in Washington, you need prior authorization demonstrating progressive keratoconus through serial corneal topography. Your ophthalmologist submits documentation via Cigna's provider portal showing disease progression, failed conservative treatments, and medical necessity. Standard

How to Get Takhzyro (lanadelumab-flyo) Covered by Blue Cross Blue Shield in New Jersey: Complete PA Forms and Appeals Guide

Answer Box: Getting Takhzyro Covered in New Jersey Horizon Blue Cross Blue Shield of New Jersey requires prior authorization for Takhzyro (lanadelumab-flyo) with confirmed HAE Type I/II diagnosis via C4/C1-INH labs, attack history documentation, and specialist prescription. Submit PA through provider portal with medical necessity letter; if denied,

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Mepsevii Covered by Aetna CVS Health in Virginia Mepsevii (vestronidase alfa-vjbk) requires prior authorization from Aetna CVS Health under Clinical Policy Bulletin 0442. Key requirements: confirmed MPS VII diagnosis via enzyme assay or genetic testing, prescription by a metabolic specialist, and elevated urinary glycosaminoglycans ≥2x normal levels.

How to Get Berinert Approved by Humana in North Carolina: PA Forms, Appeals, and Alternative Coverage Paths

Answer Box: Getting Berinert Covered by Humana in North Carolina Humana requires prior authorization (PA) for Berinert (C1-esterase inhibitor, IV) for hereditary angioedema (HAE) treatment. Submit PA requests through Humana's provider portal with HAE diagnosis confirmation, attack history, and specialist prescription. If denied, you have 65 days to

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

Answer Box: Getting Naglazyme (Galsulfase) Covered by Cigna in Washington Cigna requires prior authorization for Naglazyme (galsulfase) with strict medical necessity criteria. To get approved in Washington: (1) Have your genetics/metabolism specialist complete Cigna's CCRD PA form with confirmed MPS VI diagnosis via enzyme assay or genetic

How Long Does It Take to Get Synagis (Palivizumab) Approved by Blue Cross Blue Shield in Virginia? Complete Timeline Guide

Answer Box: Synagis Approval Timeline in Virginia Blue Cross Blue Shield Virginia (Anthem) requires prior authorization for Synagis (palivizumab), typically taking 5-14 days for standard reviews. High-risk infants (≤35 weeks gestation, chronic lung disease, congenital heart disease) have the best approval odds when complete clinical documentation is submitted upfront. Start

How to Get Besponsa (inotuzumab ozogamicin) Covered by Aetna (CVS Health) in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Besponsa Covered in Virginia Aetna (CVS Health) requires prior authorization for Besponsa (inotuzumab ozogamicin) in Virginia. The fastest path to approval: 1) Confirm CD22-positive B-cell ALL with ≥5% blasts via flow cytometry, 2) Document relapsed/refractory status after ≥1 prior therapy, 3) Submit complete PA packet to

How to Get Taltz (Ixekizumab) Covered by Blue Cross Blue Shield in Virginia: Complete Coding, Prior Authorization, and Appeals Guide

Quick Answer: Blue Cross Blue Shield Virginia (Anthem BCBS) requires prior authorization for Taltz (ixekizumab), with step therapy mandating failure of TNF inhibitors. Submit PA via Availity Provider Portal with proper ICD-10 codes (L40.0 for plaque psoriasis), HCPCS J3590, and documented prior therapy failures. If denied, you have 180

Get Xospata (Gilteritinib) Covered by Cigna in Virginia: Provider Partnership Guide with Forms and Appeals

Answer Box: Fast Track to Xospata Coverage Xospata (gilteritinib) requires prior authorization from Cigna in Virginia for relapsed/refractory AML with confirmed FLT3 mutations. Your hematologist-oncologist must submit documentation through Express Scripts/Accredo or EviCore pathways. Key requirements: FLT3 mutation test results, prior therapy history, and medical necessity letter. Standard