Counterforce Health Team

How to Get Filspari (sparsentan) Covered by Humana in Michigan: Complete PA Guide and Appeal Process

Answer Box: Your Path to Filspari Coverage To get Filspari (sparsentan) covered by Humana in Michigan: You need biopsy-proven IgA nephropathy with persistent proteinuria ≥1g/day despite ACE inhibitor/ARB therapy, plus enrollment in the FDA REMS program with quarterly liver function tests. Submit prior authorization through your nephrologist using

How to Get Opfolda (miglustat) Covered by UnitedHealthcare in New Jersey: Complete Coverage Guide and Appeals Process

Answer Box: Getting Opfolda Coverage in New Jersey UnitedHealthcare covers Opfolda (miglustat) only when prescribed with Pombiliti for late-onset Pompe disease (LOPD) in adults ≥40 kg who show inadequate response to current enzyme replacement therapy. Submit prior authorization via UnitedHealthcare Provider Portal with documented ERT failure evidence. If denied, appeal

Getting Zolgensma Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Cigna in New Jersey Zolgensma (onasemnogene abeparvovec-xioi) requires prior authorization from Cigna but is covered as a one-time specialty medication. For fastest approval: 1) Submit PA with genetic confirmation (≤3 SMN2 copies), anti-AAV9 titer ≤1:50, and baseline labs through CoverMyMeds or Cigna provider

How to Get Voxzogo (vosoritide) Approved by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Voxzogo Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Voxzogo (vosoritide) in children under 18 with confirmed achondroplasia and open growth plates. The fastest path: have your pediatric endocrinologist or geneticist submit the PA Medical Necessity form via the OptumRx Provider Portal with genetic testing

Getting Kymriah Approved by UnitedHealthcare in Pennsylvania: Complete Coverage Guide with Appeals Process

Answer Box: Fast Track to Kymriah Coverage UnitedHealthcare covers Kymriah (tisagenlecleucel) as a medical benefit requiring prior authorization through OptumHealth Transplant Solutions. Key requirements: CD19+ confirmed disease, ≥2 prior therapy failures, treatment at FACT-accredited center. First step today: Verify your plan includes transplant benefits and confirm your treatment center is

How to Get Keytruda (Pembrolizumab) Covered by Humana in New York: Complete PA Guide and Appeal Scripts

Answer Box: Getting Keytruda (Pembrolizumab) Covered by Humana in New York Humana Medicare Advantage plans require prior authorization (PA) for Keytruda, covering it as a Part B medical benefit at 80% after deductible. You'll need FDA-approved biomarker testing (PD-L1, MSI-H, or TMB-H), staging documentation, and medical necessity letters.

How to Get Krystexxa (Pegloticase) Covered by Humana in Michigan: Complete PA Forms and Appeals Guide

Answer Box: Getting Krystexxa Covered by Humana in Michigan Krystexxa (pegloticase) requires prior authorization from Humana Medicare Advantage plans in Michigan. Your fastest path to approval: (1) Verify your rheumatologist has documented failure of allopurinol and febuxostat at maximum doses for ≥3 months each, (2) Submit PA request via Humana

Work With Your Doctor to Get Fintepla (Fenfluramine) Approved by Blue Cross Blue Shield in California: Complete Provider Collaboration Guide

Answer Box: Getting Fintepla Approved in California Fintepla (fenfluramine) requires prior authorization from Blue Cross Blue Shield California, including REMS enrollment documentation and echocardiogram results to confirm eligibility for Dravet or Lennox-Gastaut syndrome. Your doctor must first enroll as a prescriber and enroll you as a patient at FinteplaREMS.com,

Lowering Out-of-Pocket Costs for Darzalex (Daratumumab) with UnitedHealthcare in New Jersey: Copay Cards, Appeals, and Financial Assistance

Answer Box: Reducing Darzalex Costs with UnitedHealthcare in New Jersey Darzalex (daratumumab) costs with UnitedHealthcare can be reduced through Janssen CarePath copay assistance ($5-10 per infusion, $15,000 annual cap for commercial plans), tier exception requests for high specialty tiers, and New Jersey's external appeal process via IHCAP.

Getting Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) Covered by Aetna CVS Health in Michigan: Prior Authorization, Appeals, and Alternative Options

Quick Answer: Getting Trikafta Covered by Aetna CVS Health in Michigan Trikafta requires prior authorization from Aetna CVS Health with CFTR genotype testing (≥1 F508del mutation), cystic fibrosis diagnosis (ICD-10 E84.x), age ≥2 years, and baseline liver function tests. Submit via CVS Caremark Specialty pharmacy with 2+ weeks lead