Counterforce Health Team

Counterforce Health Team

How to Get Mavenclad (Cladribine) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered by Aetna CVS Health in Michigan Mavenclad (cladribine tablets) requires prior authorization from Aetna CVS Health for relapsing MS coverage. Key requirements: documented failure of ≥2 DMTs, baseline lymphocyte count ≥800 cells/μL, neurologist prescriber, and comprehensive safety screening. Submit PA via Aetna provider portal
5 min read

Renewing Approval for Kalydeco (Ivacaftor) with Blue Cross Blue Shield in California: What to Prepare & When

Answer Box: Kalydeco Renewal Essentials Renew your Kalydeco (ivacaftor) authorization with Blue Cross Blue Shield of California 2-4 weeks before expiration. Submit via AuthAccel portal with updated clinic notes, liver function tests, FEV₁ data, and adherence documentation. Most renewals require proof of ongoing benefit (stable/improved lung function, reduced exacerbations)
6 min read

Getting Therakos CELLEX Photopheresis Covered by Cigna in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Therakos CELLEX Covered by Cigna in Pennsylvania Yes, Cigna covers Therakos CELLEX photopheresis for FDA-approved indications like cutaneous T-cell lymphoma (CTCL) and steroid-refractory graft-versus-host disease (GVHD), but prior authorization is required. Submit your PA through Cigna's provider portal with detailed documentation of failed prior therapies
6 min read

How to Get Zolgensma (onasemnogene abeparvovec) Covered by Cigna in Ohio: Complete Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Zolgensma Covered by Cigna in Ohio Cigna requires prior authorization for Zolgensma (onasemnogene abeparvovec) using their Gene Therapy PA form, with extensive clinical documentation including genetic testing, baseline labs, and age verification. Submit via fax to 833-910-1625 with all supporting documents. If denied, Ohio residents have internal
6 min read

Myths vs. Facts: Getting Synagis (Palivizumab) Covered by Aetna (CVS Health) in New Jersey

Answer Box: Fast Track to Synagis Approval in New Jersey Synagis (palivizumab) requires prior authorization from Aetna (CVS Health) with step therapy mandating Beyfortus (nirsevimab) first-line unless contraindicated. High-risk infants (<29 weeks gestation, chronic lung disease, or hemodynamically significant congenital heart disease) need specialist documentation and proof Beyfortus is
6 min read