Counterforce Health Team

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

How to Get Oxervate (Cenegermin) Covered by Humana in Illinois: Appeals Guide and Medical Necessity Templates

Answer Box: Getting Oxervate (Cenegermin) Covered by Humana in Illinois Humana requires prior authorization for Oxervate (cenegermin) as a specialty-tier Part D drug for stage 2-3 neurotrophic keratitis. Your fastest path to approval: (1) Verify formulary status via Humana's PA Search Tool, (2) Submit PA request with confirmed

How to Get Symdeko/Symkevi (Tezacaftor/Ivacaftor) Covered by Humana in Illinois: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Symdeko/Symkevi Covered by Humana in Illinois Humana typically requires prior authorization for Symdeko/Symkevi (tezacaftor/ivacaftor) and often classifies it as non-formulary, requiring a formulary exception. To get coverage in Illinois: (1) Submit a complete prior authorization with CF diagnosis, CFTR genotype showing F508del mutation, age

Get Eylea and Lucentis Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Started To get Eylea or Lucentis covered by Humana in California: First, check if your plan requires step therapy through bevacizumab (Avastin). If yes, document any prior anti-VEGF treatment failures or contraindications. Submit prior authorization via the Humana provider portal with OCT imaging, visual acuity measurements, and

Myths vs. Facts: Getting Garadacimab Covered by Aetna (CVS Health) in Washington - Complete Prior Authorization Guide

Answer Box: Getting Garadacimab Covered by Aetna in Washington Garadacimab requires prior authorization from Aetna (CVS Health) with confirmed HAE diagnosis, specialist prescription, and often documented failures of step-therapy alternatives. Washington residents have strong appeal rights through the Office of Insurance Commissioner, including expedited reviews (72 hours) and binding external