Counterforce Health Team

Get Signifor LAR (Pasireotide) Covered by Blue Cross Blue Shield in Florida: 2025 Prior Authorization Guide

Quick Answer: Your Path to Coverage Yes, Florida Blue covers Signifor LAR (pasireotide) for Cushing's disease and acromegaly, but requires prior authorization. The fastest path: ensure your endocrinologist has documented failed surgery or contraindications, recent labs (UFC for Cushing's, IGF-1 for acromegaly), and baseline tests within

How to Get Humira (adalimumab) Covered by Aetna (CVS Health) in Washington: Complete Appeals Guide with State Protections

Quick Answer: Getting Humira (adalimumab) Approved by Aetna (CVS Health) in Washington Most Aetna CVS Health plans in Washington require prior authorization for Humira (adalimumab) and often prefer biosimilars first. Your fastest path: 1) Download the Humira PA form for CVS Health (Aetna) specific to your plan, 2) Document any

Blue Cross Blue Shield New Jersey Coverage for Hetlioz LQ (Tasimelteon): Complete PA Guide and Appeals Process

Answer Box: Getting Hetlioz LQ Covered in New Jersey Blue Cross Blue Shield of New Jersey requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) for Smith-Magenis syndrome patients ages 3-15, with documented melatonin failure for 6+ months. Submit through your sleep specialist via Horizon's provider portal with

Work With Your Doctor to Get Defitelio (Defibrotide) Approved by Aetna (CVS Health) in California: Complete Guide With Forms and Appeals

Answer Box: Getting Defitelio (Defibrotide) Approved by Aetna (CVS Health) in California Defitelio (defibrotide) requires prior authorization from Aetna (CVS Health) for severe hepatic veno-occlusive disease (VOD/SOS) with organ dysfunction post-stem cell transplant. The fastest path to approval: (1) Have your transplant team submit the PA through Aetna'

How to Get Opzelura (Ruxolitinib Cream) Covered by Humana in Pennsylvania: Prior Authorization Guide and Appeal Process

Answer Box: Your Path to Opzelura Coverage Opzelura (ruxolitinib cream) requires prior authorization from Humana Medicare Advantage plans in Pennsylvania. Your dermatologist must document failed trials of at least two topical treatments (like corticosteroids and calcineurin inhibitors) for atopic dermatitis, or failed conventional therapies for vitiligo. Submit requests through Humana&

How to Get Eloctate Covered by Cigna in Georgia: Prior Authorization Guide, Appeals Process & Alternative Options

Quick Answer: Getting Eloctate Covered by Cigna in Georgia Eloctate (efmoroctocog alfa) requires prior authorization from Cigna and is classified as a specialty medication limited to 30-day supplies through Accredo pharmacy. Your hematologist must submit a Hemophilia Factor VIII CCRD Prior Authorization Form documenting your hemophilia A diagnosis, bleeding history,

How to Get Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Exondys 51 Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Exondys 51 (eteplirsen) with specific criteria: confirmed DMD with exon 51-amenable mutation, ambulatory status, specialist prescriber, and baseline testing. First step: Contact a DMD specialist at Mount Sinai or NYU Langone to order genetic

Myths vs. Facts: Getting Alecensa (alectinib) Covered by Blue Cross Blue Shield in Virginia

Answer Box: The Reality of Getting Alecensa Covered in Virginia Myth: If your oncologist prescribes Alecensa (alectinib), Blue Cross Blue Shield must cover it automatically. Fact: Anthem Blue Cross Blue Shield Virginia requires prior authorization for Alecensa, with specific ALK-positive NSCLC documentation and potential step therapy requirements. Most denials stem

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Cigna in Pennsylvania: Complete Appeals Guide with Forms & Timelines

Answer Box: Getting Enhertu Covered by Cigna in Pennsylvania Fastest path to approval: Submit prior authorization through Cigna's provider portal with documented HER2-positive status, prior therapy failures, and NCCN guideline support. If denied, request peer-to-peer review within 7-14 days, then file internal appeals within 180 days. Pennsylvania residents

How to Get Palynziq (pegvaliase-pqpz) Covered by Humana in North Carolina: PA Requirements, Appeals, and State Resources

Answer Box: Getting Palynziq Covered by Humana in North Carolina Humana requires prior authorization for Palynziq (pegvaliase-pqpz), typically placed on the highest specialty tier. To get coverage in North Carolina: (1) Submit PA through Humana's provider portal with confirmed PKU diagnosis, blood phenylalanine >600 µmol/L, and