Counterforce Health Team

Do You Qualify for StrataGraft Coverage by UnitedHealthcare in Georgia? Decision Tree & Next Steps

Answer Box: Getting StrataGraft Covered by UnitedHealthcare in Georgia Quick Answer: StrataGraft requires prior authorization through UnitedHealthcare's medical benefit (not pharmacy) for adults 18+ with deep partial-thickness thermal burns requiring surgical intervention. Submit via the UnitedHealthcare Provider Portal with wound measurements, photos, and burn surgeon documentation. If denied,

How to Get Vitrakvi (Larotrectinib) Covered by Aetna CVS Health in Illinois: PA Forms, Appeal Scripts & Timeline Guide

Quick Answer: Aetna CVS Health requires prior authorization for Vitrakvi (larotrectinib) with documented NTRK gene fusion testing and evidence of metastatic/unresectable disease. Submit PA via CVS Specialty at 1-888-267-3277 with molecular pathology report, oncologist notes, and prior therapy documentation. If denied, appeal within 180 days using medical necessity letter

Work With Your Doctor to Get Vyondys 53 (Golodirsen) Approved by Blue Cross Blue Shield in California

Quick Answer: Getting Vyondys 53 Approved in California To get Vyondys 53 (golodirsen) covered by Blue Cross Blue Shield in California, you'll need: genetic testing confirming DMD with exon 53-amenable mutation, prior authorization through your doctor, and detailed documentation of medical necessity. Start by scheduling a visit with

Myths vs. Facts: Getting Voxzogo (vosoritide) Covered by Blue Cross Blue Shield in Georgia (Complete PA Guide)

Answer Box: Voxzogo Coverage by Blue Cross Blue Shield in Georgia To get Voxzogo (vosoritide) covered by Blue Cross Blue Shield in Georgia: Your child needs confirmed achondroplasia with open growth plates, genetic testing (FGFR3 variant), and prescription from a pediatric endocrinologist. Submit prior authorization with growth data and medical

Getting Helixate (rFVIII) Covered by Blue Cross Blue Shield in Washington: Complete Appeals Guide with State Protections

Quick Answer: Your Path to Coverage Getting Helixate (antihemophilic factor, rFVIII) covered by Blue Cross Blue Shield in Washington requires navigating prior authorization, potential step therapy, and Washington's strong external review protections. Start with a formulary exception request through your plan's pharmacy services, backed by detailed

Coding That Helps Get Tegsedi (inotersen) Approved by Cigna in Florida: ICD-10, HCPCS/J-Code, and NDC Guide

Answer Box: Getting Tegsedi (inotersen) Coded Correctly for Cigna Coverage in Florida Fastest path to approval: Use ICD-10 code E85.1 (neuropathic heredofamilial amyloidosis), HCPCS J3490 (unclassified drugs) with NDC 72126-0007-02, and submit via Cigna's electronic PA system through Express Scripts/Accredo. Tegsedi requires prior authorization under the

How to Get Hetlioz LQ (tasimelteon oral suspension) Covered by Cigna in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Cigna requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) for Smith-Magenis syndrome in children 3-15 years old. Submit PA through Express Scripts/Accredo with genetic SMS confirmation, sleep specialist evaluation, and documented failures of ramelteon plus one alternative. Appeals follow Illinois's strong patient protection laws

How to Get Hetlioz (Tasimelteon) Covered by Humana in California: Prior Authorization Forms, Appeals, and Step-by-Step Guide

Answer Box: Getting Hetlioz (Tasimelteon) Covered by Humana in California Hetlioz (tasimelteon) requires prior authorization from Humana Medicare Advantage plans in California for both Non-24-hour sleep-wake disorder and Smith-Magenis syndrome. The fastest path: 1) Verify your plan's formulary status via Humana's PA Search Tool, 2) Submit

How to Get Ozempic and Mounjaro Covered by Aetna CVS Health in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Ozempic/Mounjaro Covered by Aetna CVS Health in Georgia To get Ozempic or Mounjaro covered by Aetna CVS Health in Georgia: Your doctor must submit prior authorization showing type 2 diabetes diagnosis, recent A1c, and documented metformin trial/failure. If denied, file internal appeal within 180 days,

Myths vs. Facts: Getting Filsuvez (birch triterpenes topical gel) Covered by UnitedHealthcare in Pennsylvania

Answer Box: Getting Filsuvez (birch triterpenes topical gel) covered by UnitedHealthcare in Pennsylvania requires prior authorization with genetic confirmation of dystrophic or junctional epidermolysis bullosa, wound documentation, and age ≥6 months. First step: enroll in Chiesi Total Care for PA support. If denied, Pennsylvania's external review program overturns