Counterforce Health Team

How to Get Duopa (Carbidopa/Levodopa Enteral) Covered by Cigna in California: Prior Authorization Guide and Appeals Process

Answer Box: Cigna covers Duopa (carbidopa/levodopa enteral) with prior authorization for advanced Parkinson's disease patients experiencing motor fluctuations despite optimized oral therapy. Three steps to approval: 1) Your neurologist submits PA documentation showing failed oral carbidopa/levodopa trials and ≥3 hours daily OFF time, 2) Cigna reviews

Myths vs. Facts: Getting Tecentriq (Atezolizumab) Covered by UnitedHealthcare in New York

Answer Box: Getting Tecentriq Covered by UnitedHealthcare in New York Myth: If your doctor prescribes Tecentriq, UnitedHealthcare automatically covers it. Fact: UnitedHealthcare requires prior authorization (PA) for Tecentriq (HCPCS J9022) with specific documentation including PD-L1 testing, staging, and prior treatment history. In New York, you have strong appeal rights through

How to Get Uptravi (Selexipag) Covered by Aetna (CVS Health) in Illinois: Prior Authorization Forms, Appeals Process, and Approval Timeline

Answer Box: Getting Uptravi (Selexipag) Covered by Aetna (CVS Health) in Illinois Yes, Aetna (CVS Health) covers Uptravi (selexipag) for WHO Group I pulmonary arterial hypertension with prior authorization. The fastest path: gather your right heart catheterization report, WHO functional class documentation, and 6-minute walk test results. Submit the Illinois-specific

The Requirements Checklist to Get Eloctate (Coagulation Factor VIII) Covered by Humana in Illinois

Answer Box: Getting Eloctate Covered by Humana in Illinois Eloctate requires prior authorization from Humana but is classified as a preferred Factor VIII product with no step therapy requirements. Submit PA via Humana provider portal with hematologist documentation including hemophilia A diagnosis (ICD-10 D66), bleeding history, and weight-based dosing rationale.

Myths vs. Facts: Getting Breyanzi (lisocabtagene maraleucel) Covered by Aetna (CVS Health) in Florida

Quick Answer: Aetna (CVS Health) requires prior authorization for Breyanzi (lisocabtagene maraleucel) under Clinical Policy Bulletin #986, covering FDA-approved B-cell lymphoma indications for patients ≥18 with ECOG ≤2 after documented treatment failures. Submit PA via Availity portal or fax 1-877-269-9916 with complete clinical documentation. If denied, file internal appeal within

How to Get Vanflyta (Quizartinib) Covered by Aetna CVS Health in Illinois: Complete Approval Timeline and Appeals Guide

Answer Box: Getting Vanflyta Covered by Aetna CVS Health in Illinois Vanflyta (quizartinib) requires prior authorization from Aetna CVS Health for FLT3-ITD-positive AML, with approval typically taking 30-45 days for standard review or ≤72 hours if expedited. Key requirements: FLT3-ITD mutation documentation, baseline EKG showing QTc ≤450ms, and hematologist prescription.

If Elfabrio Isn't Approved by Humana in Pennsylvania: Formulary Alternatives & Exception Paths

Answer Box: Your Options When Humana Denies Elfabrio in Pennsylvania Elfabrio (pegunigalsidase alfa) isn't on Humana's standard formulary, but you have three paths: request a formulary exception for Elfabrio coverage, try Fabrazyme (the preferred alternative), or appeal through Pennsylvania's external review if commercial coverage.

Get Ferriprox (Deferiprone) Covered by Cigna in Virginia: Complete PA Guide and Appeal Scripts

Answer Box: Your Fastest Path to Approval Cigna requires prior authorization for Ferriprox (deferiprone) through Express Scripts/Accredo specialty pharmacy. Submit the Iron Chelating Agents PA form with documented serum ferritin >1,000 mcg/L (thalassemia) or >300 mcg/L (other transfusional overload), baseline ANC ≥1.5×10⁹

How to Get Hemlibra (Emicizumab) Covered by Humana in California: Complete PA Guide & Appeal Scripts

Answer Box: Getting Hemlibra Covered by Humana in California Quick Path to Approval: Hemlibra (emicizumab-kxwh) requires prior authorization from Humana, with step therapy often requiring factor VIII trial first. Submit PA with factor VIII activity <1%, bleeding history, and inhibitor status. If denied, file internal appeal within 65 days,

How to Get Humira (adalimumab) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Humira Coverage Blue Cross Blue Shield California requires prior authorization for Humira (adalimumab) with step therapy to preferred biosimilars like Hadlima. To get coverage: 1) Have your specialist submit a PA form with documented failure/intolerance of methotrexate and two preferred biologics, 2) Include TB/