Counterforce Health Team

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

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Humana in Michigan: Appeals Guide and State Protections

Answer Box: Getting Procysbi Covered by Humana in Michigan Fast track to approval: Submit prior authorization through Humana's provider portal with nephropathic cystinosis diagnosis, WBC cystine levels, and medical necessity documentation. If denied, file a redetermination within 65 days, then escalate to Michigan's external review system

How to Get Myozyme (Alglucosidase Alfa) Covered by UnitedHealthcare in Georgia: Complete Appeals Guide with Forms and Timelines

UnitedHealthcare requires prior authorization for Myozyme (alglucosidase alfa) in Georgia with confirmed Pompe disease diagnosis, specialist documentation, and genetic testing. Submit via the UHC Provider Portal with enzyme assay results, GAA genetic confirmation, and medical necessity letter. If denied, file internal appeals within 180 days, then Georgia external review within

How to Get Luxturna Covered by UnitedHealthcare in Virginia: Complete Forms Guide and Appeal Process

Answer Box: Getting Luxturna Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Luxturna through OptumRx, with strict criteria including confirmed biallelic RPE65 mutations and retinal viability testing. Start today: (1) Verify your plan uses OptumRx for specialty drugs, (2) obtain CLIA-certified genetic testing showing biallelic RPE65 mutations, and

How to Get Helixate (Antihemophilic Factor, rFVIII) Covered by Aetna CVS Health in Michigan: Complete Coverage Guide with Appeals Process

Quick Answer: Getting Helixate Covered by Aetna CVS Health in Michigan Important Update: Helixate (antihemophilic factor, rFVIII) has been discontinued by the manufacturer. Aetna CVS Health now covers alternative factor VIII products like Kovaltry, Advate, and Jivi with prior authorization. First step: Contact your hematologist to select an alternative and

How to Get Skyrizi (risankizumab) Covered by Blue Cross Blue Shield of Michigan: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Skyrizi Covered by Blue Cross Blue Shield of Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Skyrizi (risankizumab) with specific step therapy requirements. For Crohn's disease, you need documented failure of conventional therapy (steroids for ≥7 days, immunomodulators for ≥2 months). Submit

How to Get Aldurazyme (Laronidase) Covered by Aetna (CVS Health) in Michigan: Complete Timeline & Appeals Guide

Answer Box: Getting Aldurazyme Covered by Aetna (CVS Health) in Michigan Aldurazyme (laronidase) requires prior authorization from Aetna (CVS Health) for all Michigan plans. The fastest approval path involves: (1) confirming MPS I diagnosis with genetic/enzyme testing, (2) having your specialist submit complete PA documentation via Availity portal, and

How to Get Uptravi (Selexipag) Covered by UnitedHealthcare in California: Complete Guide with Forms, Appeals, and Timelines

Answer Box: Getting Uptravi Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Uptravi (selexipag) and typically enforces step therapy requiring prior trials of other PAH medications. To get approval: 1) Submit PA through the UnitedHealthcare Provider Portal with complete WHO Group I PAH documentation and medication history, 2)

A Realistic Alecensa (Alectinib) Approval Scenario with Cigna in Pennsylvania (From Request to Yes)

Answer Box: Getting Alecensa (Alectinib) Approved by Cigna in Pennsylvania Quick Path to Approval: Cigna requires prior authorization for Alecensa (alectinib) in ALK-positive NSCLC. Submit documented ALK-positive test results, pathology confirming NSCLC, and prescriber attestation via Cigna's PA portal. Most approvals occur within 72 hours for metastatic cases;

How to Get Hemgenix (etranacogene dezaparvovec) Covered by Humana in Washington: Complete Requirements Guide

Answer Box: Get Hemgenix (etranacogene dezaparvovec) Covered by Humana in Washington Fastest path to approval: Hemgenix requires prior authorization from Humana with documented severe hemophilia B (Factor IX ≤2%), current Factor IX prophylaxis with breakthrough bleeding, and submission through CenterWell Specialty Pharmacy. First step today: Gather your hemophilia treatment records