Counterforce Health Team

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

Aldurazyme (laronidase) Approval with Cigna in Washington: Complete Guide with Forms, Appeals, and Timelines

Answer Box: Getting Aldurazyme Covered by Cigna in Washington Cigna covers Aldurazyme (laronidase) for MPS I with prior authorization requiring genetic/enzymatic confirmation and specialist involvement. Submit through Cigna's provider portal with completed PA form, genetic test results showing IDUA gene variants or enzyme deficiency, and specialist consultation

Renewing Tepezza (Teprotumumab) Approval with Aetna CVS Health in New York: Complete Guide to Documentation and Timelines

Answer Box: Renewing Tepezza Coverage Most Aetna CVS Health plans limit Tepezza to one 8-infusion course per lifetime. Renewal beyond 8 doses requires exceptional documentation showing unmet clinical need plus peer-reviewed evidence supporting extended treatment. Start renewal requests 2-4 weeks before your final scheduled infusion. If denied, New York residents

How to Get Gilenya (Fingolimod) Covered by Aetna (CVS Health) in Texas: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Gilenya (Fingolimod) Covered by Aetna (CVS Health) in Texas Aetna requires prior authorization for Gilenya (fingolimod) with documentation of relapsing MS diagnosis, baseline safety tests (EKG, eye exam), and often proof of trying preferred first-line therapies. Your neurologist submits the PA via Aetna's provider portal

How to Get Tysabri (natalizumab) Covered by Cigna in Michigan: PA Forms, Appeals Timeline & Approval Checklist

Answer Box: Getting Tysabri Covered by Cigna in Michigan Cigna requires prior authorization for Tysabri (natalizumab) in Michigan with step therapy requirements or documented highly active MS. The fastest path: (1) Have your neurologist submit PA via Evicore by Evernorth or CoverMyMeds with JCV antibody results, recent MRI reports, and

How to Get Strensiq (Asfotase Alfa) Covered by Blue Cross Blue Shield North Carolina: Complete Forms, Appeals, and State Resources Guide

Answer Box: Getting Strensiq Covered in North Carolina Blue Cross Blue Shield North Carolina requires prior authorization for Strensiq (asfotase alfa) through their MHK Provider Portal via Blue e. Submit clinical documentation confirming pediatric-onset hypophosphatasia with genetic/biochemical evidence. If denied, file internal appeals within 180 days, then request Smart

How to Get Myozyme (Alglucosidase Alfa) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Myozyme Coverage To get Myozyme (alglucosidase alfa) covered by Cigna in North Carolina, you need: (1) confirmed Pompe disease diagnosis with GAA enzyme testing and/or genetic results, (2) prescription from a metabolic/neuromuscular specialist, and (3) prior authorization submission via Cigna's provider

Getting Zanzalintinib (XL092) Covered by UnitedHealthcare in Michigan: Clinical Trials, Compassionate Use, and Appeals Guide 2025

Answer Box: Your Path to Zanzalintinib Access Zanzalintinib (XL092) is an investigational drug not yet FDA-approved. UnitedHealthcare typically denies coverage outside clinical trials. Your fastest path: 1) Search active trials at ClinicalTrials.gov for "XL092" or contact your oncologist about STELLAR program studies, 2) If trial-ineligible, pursue Exelixis