Counterforce Health Team

Do You Qualify for Voydeya (danicopan) Coverage by Blue Cross Blue Shield in New York? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Voydeya Coverage If you have paroxysmal nocturnal hemoglobinuria (PNH) with extravascular hemolysis despite C5 inhibitor therapy, you likely qualify for Voydeya (danicopan) coverage through Blue Cross Blue Shield in New York. The fastest approval path requires: (1) Current C5 inhibitor therapy (Soliris/Ultomiris), (2)

How to Get Kineret (anakinra) Covered by Aetna (CVS Health) in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kineret (anakinra) Approved by Aetna (CVS Health) in Florida Aetna (CVS Health) requires prior authorization for Kineret (anakinra) with specific criteria: moderately to severely active rheumatoid arthritis in adults 18+, prescription from a rheumatologist, and documented failure of at least one traditional DMARD like methotrexate. Submit your

How to Get Luxturna (Voretigene Neparvovec-rzyl) Covered by Aetna CVS Health in Virginia: Complete Guide with Forms and Appeals

Answer Box: Getting Luxturna Covered by Aetna CVS Health in Virginia Luxturna requires prior authorization from Aetna CVS Health. You'll need confirmed biallelic RPE65 mutations via CLIA-certified genetic testing, proof of retinal viability (OCT showing ≥100 μm thickness), and treatment at an Aetna Institutes® GCIT Network facility. First

How to Get Onpattro (patisiran) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Onpattro Coverage To get Onpattro (patisiran) covered by Humana in New Jersey: Your prescriber must submit prior authorization with genetic testing confirming TTR variant, neurologist evaluation documenting hATTR-PN, and baseline mNIS+7 scores. Humana requires 65 days for appeals under Medicare rules. If denied, New

How to Get Pyrukynd (mitapivat) Covered by Aetna (CVS Health) in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pyrukynd (mitapivat) Covered by Aetna (CVS Health) in Georgia Aetna (CVS Health) requires prior authorization for Pyrukynd (mitapivat) as a non-formulary medication for adults with pyruvate kinase deficiency. Approval requires genetic confirmation (≥2 PKLR variants with ≥1 missense), hemoglobin ≤10 g/dL or transfusion history, and hematologist

Work With Your Doctor to Get Vimizim (Elosulfase Alfa) Approved by UnitedHealthcare in Pennsylvania: Medical Necessity Letters, Appeals, and Provider Collaboration

Answer Box: Getting Vimizim Approved in Pennsylvania UnitedHealthcare requires prior authorization for Vimizim (elosulfase alfa) through OptumRx, with strict diagnostic and functional requirements for MPS IVA patients. Your fastest path: (1) Schedule with a pediatric geneticist or metabolic specialist at Children's Hospital of Philadelphia or Nemours, (2) Gather

How to Get Opfolda (miglustat) Covered by Cigna in Texas: Complete PA Guide & Appeals Process

Answer Box: Getting Opfolda (miglustat) Covered by Cigna in Texas Cigna requires prior authorization for Opfolda (miglustat) in Texas adults with late-onset Pompe disease (LOPD) weighing ≥40 kg who aren't improving on current enzyme replacement therapy. The drug must be prescribed with Pombiliti as combination therapy. Submit PA

How to Get Givlaari (Givosiran) Covered by Florida Blue Cross Blue Shield: Complete Forms, Appeals, and Approval Guide

Quick Answer: Getting Givlaari Covered by Florida Blue in 2024 Florida Blue requires prior authorization for Givlaari (givosiran) with specific medical criteria. Submit your request through Availity.com or call 1-877-719-2583. You'll need confirmed acute hepatic porphyria diagnosis with elevated PBG/ALA levels, genetic testing, and documented attack

How to Get Tagrisso (Osimertinib) Covered by Cigna in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Tagrisso Covered by Cigna in Pennsylvania Cigna covers Tagrisso (osimertinib) with prior authorization for EGFR mutation-positive NSCLC. Your fastest path to approval: 1. Confirm EGFR mutation status via FDA-approved testing (exon 19 deletion, L858R, or T790M) 2. Submit PA through Cigna provider portal using form CNF-550 with

How Long Does It Take to Get Prolastin-C Approved by UnitedHealthcare in Virginia? Complete Timeline Guide

Quick Answer: Getting Prolastin-C approved by UnitedHealthcare in Virginia typically takes 5-7 business days for standard prior authorization or 72 hours for urgent requests. You'll need severe AAT deficiency documentation (Pi*ZZ genotype), emphysema proof via chest CT, and pulmonary function tests. If denied, Virginia gives you 120