Counterforce Health Team

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

Myths vs. Facts: Getting Galafold (migalastat) Covered by Cigna in Ohio

Answer Box: Getting Galafold Covered by Cigna in Ohio Eligibility: Adults (18+) with Fabry disease and a confirmed amenable GLA variant. Fastest path: Have your Fabry specialist submit prior authorization with genetic test results showing amenable mutation, medical necessity letter, and confirmation you're not on concurrent ERT. First

Myths vs. Facts: Getting Voydeya (danicopan) Covered by Aetna (CVS Health) in New York

Answer Box: Getting Voydeya (danicopan) Covered by Aetna (CVS Health) in New York Voydeya (danicopan) requires prior authorization from Aetna CVS Health for PNH patients with extravascular hemolysis. Key requirements include confirmed PNH diagnosis by flow cytometry, current C5 inhibitor therapy, documented EVH evidence (labs showing persistent anemia/hemolysis), REMS

How to Get Zokinvy (lonafarnib) Covered by Aetna (CVS Health) in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zokinvy (lonafarnib) Covered by Aetna (CVS Health) in Ohio Zokinvy (lonafarnib) requires prior authorization from Aetna (CVS Health) and must be dispensed through CVS Specialty Pharmacy. Key requirements include genetic confirmation of HGPS or progeroid laminopathy, patient age ≥12 months with BSA ≥0.39 m², and specialist

Do You Qualify for Gilenya (Fingolimod) Coverage by UnitedHealthcare in California? Decision Tree & Next Steps

Answer Box: Getting Gilenya Covered by UnitedHealthcare in California Most likely eligible if: You have relapsing MS, tried 2+ prior therapies (interferon, glatiramer, or dimethyl fumarate), and completed baseline EKG and eye exam. Fastest path: Have your neurologist submit prior authorization through UnitedHealthcare Provider Portal with documented treatment failures and

How to Get Sylvant (siltuximab) Covered by Cigna in Virginia: Appeals Process, Forms, and Medical Necessity Templates

Quick Answer: Getting Sylvant (siltuximab) Covered by Cigna in Virginia Cigna requires prior authorization for Sylvant (siltuximab) using their specific PA form, which must document HIV-negative and HHV-8-negative status for multicentric Castleman disease. If denied, you have 180 days to appeal internally, then 120 days to file external review with