Counterforce Health Team

Work With Your Doctor to Get Jynarque (Tolvaptan) Approved by Cigna in California: PA Requirements and Appeals Guide

Answer Box: Getting Jynarque (Tolvaptan) Approved by Cigna in California Cigna requires prior authorization for Jynarque (tolvaptan) via Express Scripts for adults ≥18 with rapidly progressing ADPKD. Your nephrologist must document eGFR decline ≥3.0 mL/min/1.73m²/year OR Mayo Classification 1C-1E, plus baseline eGFR ≥25, REMS enrollment,

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

Answer Box: UnitedHealthcare requires prior authorization for Poteligeo (mogamulizumab-kpkc) for relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy. Submit via UHC Provider Portal with staging documentation, prior therapy records, and medical necessity letter from oncologist/dermatologist. If denied, appeal within 180 days or request Georgia external

Myths vs. Facts: Getting Natpara (Parathyroid Hormone) Covered by Aetna CVS Health in Michigan

Important Update: Takeda will permanently discontinue all Natpara shipments on December 31, 2025. New patient starts are typically denied due to no commercial supply. If you're currently on Natpara through the Special Use Program, work with your endocrinologist immediately to plan your transition to alternatives like Yorvipath or

How to Get Juxtapid (lomitapide) Covered by Cigna in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Juxtapid (lomitapide) Covered by Cigna in Georgia Eligibility: Cigna covers Juxtapid (lomitapide) for adults with homozygous familial hypercholesterolemia (HoFH) who've failed maximally tolerated statin + ezetimibe + PCSK9 inhibitor therapy, with LDL-C >70 mg/dL (ASCVD) or >100 mg/dL (no ASCVD). Fastest path: (1)

The Requirements Checklist to Get Strimvelis Gene Therapy Covered by Cigna in Michigan: Forms, Appeals, and Milan Treatment Guide

Answer Box: Getting Strimvelis Covered by Cigna in Michigan Strimvelis requires prior authorization through Cigna's Express Scripts specialty pharmacy division using their Non-Specific Gene Therapy form. Key requirements: confirmed ADA-SCID diagnosis with bi-allelic ADA gene mutations, documented absence of HLA-matched related donor, and failed/contraindicated PEG-ADA enzyme replacement

Get Tecentriq (Atezolizumab) Covered by Humana in Virginia: Complete Prior Authorization & Appeals Guide

Answer Box: Quick Path to Coverage Tecentriq (atezolizumab) requires prior authorization from Humana and must be dispensed through specialty pharmacies like CenterWell. In Virginia, if denied, you have 65 days to appeal and can request expedited external review through the State Corporation Commission if delays risk serious harm. First steps

Myths vs. Facts: Getting Gamifant (Emapalumab) Covered by Aetna CVS Health in North Carolina

Answer Box: Getting Gamifant (Emapalumab) Covered by Aetna CVS Health in North Carolina Fastest path to approval: Submit prior authorization through CVS Caremark portal with documented primary HLH diagnosis (HLH-2004 criteria), proof of conventional therapy failure (etoposide + dexamethasone), and hematologist medical necessity letter. If denied, use North Carolina's

How to Get Naglazyme (Galsulfase) Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Naglazyme (Galsulfase) Covered by Humana in California Humana requires prior authorization for Naglazyme (galsulfase) for MPS VI. Your fastest path: (1) Submit complete PA with enzyme assay, genetic testing, and baseline functional measures (6-minute walk test, stair climbing capacity), (2) If denied, file internal appeal within 65

Renewing Acthar Gel Coverage with UnitedHealthcare in New Jersey: Complete Timeline and Documentation Guide

Answer Box: Renewing Acthar Gel with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization renewal for Acthar Gel, but all reauthorization requests are automatically denied for most conditions—continuation requires appealing to the UHC Pharmacy appeals team. Start your renewal process 2-4 weeks before your current authorization expires to avoid

The Complete Requirements Checklist to Get Revlimid (lenalidomide) Covered by Cigna in New Jersey

Answer Box: Getting Revlimid (lenalidomide) Covered by Cigna in New Jersey Fastest path to approval: Submit electronic prior authorization (PA) through CoverMyMeds or EviCore with complete REMS enrollment, diagnosis documentation (ICD-10 codes C90.0 for multiple myeloma, D46.Z for MDS, C83.1 for mantle cell lymphoma), and prior therapy