Counterforce Health Team

Counterforce Health Team

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

Answer Box: Getting Cerezyme Covered by Aetna CVS Health in Texas Aetna CVS Health requires prior authorization for Cerezyme (imiglucerase) with Elelyso as preferred step therapy. Texas law provides strong appeal protections with 180-day filing deadlines and binding external review through Independent Review Organizations (IROs). Fastest path to approval: 1.
6 min read

How to Get Elaprase (idursulfase) Covered by UnitedHealthcare in Washington: Prior Authorization Guide and Appeal Process

Answer Box: Getting Elaprase (idursulfase) Covered in Washington To get Elaprase (idursulfase) approved by UnitedHealthcare in Washington, you need: (1) prior authorization with genetic/enzymatic confirmation of Hunter syndrome (MPS II), (2) weight-based dosing calculations, and (3) an infusion monitoring plan. If denied, Washington gives you 60 days to request
7 min read

How to Get Amvuttra (Vutrisiran) Covered by Aetna CVS Health in New Jersey: Prior Authorization Guide and Appeal Process

Answer Box: Fast Track to Amvuttra Coverage Aetna CVS Health requires prior authorization for Amvuttra (vutrisiran) in New Jersey with step therapy after Onpattro unless contraindicated. Submit PA with confirmed hATTR-PN or ATTR-CM diagnosis, genetic testing (TTR mutation), specialist evaluation, and documented failure/intolerance to preferred alternatives. Appeals follow a
5 min read

How to Get Filsuvez Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Filsuvez Covered by Humana in Washington Humana Medicare Advantage plans require prior authorization for Filsuvez (birch triterpenes topical gel) to treat confirmed dystrophic or junctional epidermolysis bullosa in patients ≥6 months old. Success requires genetic testing results (COL7A1, LAMA3), wound documentation (10-50 cm²), and failed prior treatments.
6 min read

How to Get Revlimid (Lenalidomide) Covered by Blue Cross Blue Shield Michigan: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Revlimid Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Revlimid (lenalidomide) through their Oncology Value Management program. The fastest path to approval involves three key steps: (1) Ensure REMS compliance documentation is complete, (2) Submit PA request via OncoHealth with complete
5 min read

How to Get Cystadane (betaine anhydrous) Covered by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Cystadane Covered in Texas Blue Cross Blue Shield of Texas requires prior authorization for Cystadane (betaine anhydrous) for homocystinuria. Submit through Carelon Medical Benefits Management at 1-866-455-8415 or via Availity with diagnosis confirmation, lab results showing elevated homocysteine (>50 µmol/L), and documentation of vitamin therapy
6 min read

How to Get Orladeyo (Berotralstat) Covered by Cigna in California: Appeals Guide and Formulary Alternatives

Answer Box: Getting Orladeyo (Berotralstat) Covered by Cigna in California Cigna requires prior authorization (PA) for Orladeyo (berotralstat) for hereditary angioedema (HAE) prophylaxis. Submit through your doctor with confirmed HAE diagnosis (low C4 and C1-INH levels), age ≥12 years, and documented failure/intolerance of formulary alternatives like Takhzyro or Haegarda.
5 min read