Counterforce Health Team

How to Get Mycapssa (Octreotide Oral) Covered by Humana in Pennsylvania: Complete Prior Authorization Guide

Quick Answer: Getting Mycapssa Covered by Humana in Pennsylvania Mycapssa (oral octreotide) requires prior authorization from Humana Medicare Advantage plans in Pennsylvania. You'll need documented proof of acromegaly diagnosis, prior response to injectable somatostatin analogs (like Sandostatin LAR or Somatuline Depot), and an endocrinologist's prescription. If

How to Get Takhzyro (lanadelumab-flyo) Covered by Aetna (CVS Health) in New York: Appeals Guide and State Protections

Answer Box: Quick Path to Coverage Getting Takhzyro (lanadelumab-flyo) covered by Aetna (CVS Health) in New York requires prior authorization and meeting specific HAE criteria. Start with your doctor submitting a PA request through CVS Caremark's provider portal, including confirmed HAE type I/II diagnosis (C4/C1-INH labs)

How to Get Jakafi (Ruxolitinib) Covered by Humana in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Jakafi (Ruxolitinib) Covered by Humana in Florida Humana Medicare Advantage plans in Florida cover Jakafi (ruxolitinib) on Tier 5 (specialty tier) with prior authorization required for myelofibrosis, polycythemia vera, and GVHD indications. Your prescriber must submit documentation proving hydroxyurea failure (for PV) or intermediate/high-risk disease status

Work With Your Doctor to Get Jaypirca (Pirtobrutinib) Approved by Cigna in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Jaypirca (Pirtobrutinib) Covered by Cigna in North Carolina Cigna requires prior authorization for Jaypirca (pirtobrutinib), a specialty BTK inhibitor for relapsed mantle cell lymphoma or CLL/SLL after prior BTK inhibitor failure. Your doctor must submit clinical documentation proving prior therapy failures and medical necessity through Accredo

Get Emgality (galcanezumab-gnlm) Covered by Cigna in California: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Emgality Covered by Cigna in California Yes, Cigna covers Emgality (galcanezumab-gnlm) for migraine prevention and episodic cluster headache, but requires prior authorization. Your doctor must document that you have ≥4 migraine days per month and have tried/failed at least 2 standard preventive medications. If denied, California

How to Get Kesimpta (Ofatumumab) Covered by Aetna (CVS Health) in Georgia: Complete PA Guide and Appeal Scripts

Quick Answer: Aetna (CVS Health) requires prior authorization for Kesimpta (ofatumumab) with documented relapsing MS diagnosis, neurologist prescription, and evidence of prior DMT failures or contraindications. In Georgia, you have 180 days to appeal internal denials and 60 days for external review through the Georgia Department of Insurance. Start by

How to Get Krystexxa (Pegloticase) Covered by Humana in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Krystexxa Coverage Yes, Humana covers Krystexxa (pegloticase) in Illinois with prior authorization for chronic refractory gout. You'll need documented failure of allopurinol AND febuxostat at maximum doses for 3+ months each, plus normal G6PD test results. Submit your PA via Humana's

How to Get Garadacimab (Andembry) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Garadacimab Covered by BCBS in Washington Garadacimab (Andembry) requires prior authorization from Blue Cross Blue Shield plans in Washington. Submit a formulary exception request with confirmed HAE diagnosis (ICD-10 D84.1), lab results showing low C4 and C1-INH levels, and documentation of prior therapy failures. If denied,

Coding That Helps Get Enhertu (fam-trastuzumab deruxtecan-nxki) Approved with Humana in California: ICD-10, J-Code, and NDC Guide

Quick Answer: Coding for Enhertu (fam-trastuzumab deruxtecan-nxki) Approval Getting Enhertu covered by Humana in California requires precise coding: ICD-10 Z17.31 (HER2-positive status) paired with your cancer diagnosis (C50.-, C16.-, C34.-), J-code J9358 (1 mg units), and NDC 65597-0406-01. Submit prior authorization through Humana's Availity

How to Get Sylvant (Siltuximab) Covered by Humana in Washington: Complete PA Guide and Appeals Process

Answer Box: Getting Sylvant (Siltuximab) Covered by Humana in Washington Humana requires prior authorization for Sylvant (siltuximab) to treat HIV-negative, HHV-8-negative multicentric Castleman disease. Your provider submits the PA request via Humana's provider portal with documentation of failed prior therapies (rituximab, corticosteroids, or chemotherapy), HIV/HHV-8 test results,