Counterforce Health Team

How to Get Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in Ohio: Decision Tree, Forms & Appeals Process

Answer Box: Quick Path to Imbruvica Coverage Blue Cross Blue Shield Ohio covers Imbruvica (ibrutinib) with prior authorization for FDA-approved conditions including CLL/SLL and Waldenström's macroglobulinemia. Your fastest path: (1) Confirm your diagnosis matches FDA indications, (2) Have your oncologist submit a PA request with pathology reports

How to Get Mepsevii (Vestronidase Alfa) Covered by Humana in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Mepsevii Covered by Humana in Georgia Mepsevii (vestronidase alfa-vjbk) requires prior authorization from Humana for MPS VII (Sly Syndrome) treatment. Success depends on confirmed diagnosis documentation and specialist involvement. The fastest path: 1) Have your metabolic specialist submit PA request with enzyme assay/genetic testing results, 2)

How to Get Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) Covered by UnitedHealthcare in Florida: Complete Guide to Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Trikafta Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) with specific criteria: patient must be 2+ years old with cystic fibrosis and have at least one F508del mutation or FDA-responsive CFTR mutation confirmed by lab testing. Submit PA through OptumRx with

Renewing Lutathera (Lutetium Lu-177 Dotatate) Approval with Aetna CVS Health in Texas: Timeline, Documents, and Bridge Options

Answer Box: Renewing Your Lutathera Approval Lutathera (lutetium Lu-177 dotatate) renewal with Aetna CVS Health in Texas requires documentation of continued clinical benefit before completing all 4 doses. Most patients receive initial approval for the full 4-dose course, but if treatment was interrupted or you need continuation authorization, submit clinical

How to Get Lamzede (velmanase alfa-tycv) Covered by Cigna in North Carolina: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Lamzede Covered by Cigna in North Carolina Lamzede (velmanase alfa-tycv) typically requires prior authorization from Cigna since it's not on most 2024 formularies. Here's your fastest path to approval: 1. Submit PA request through Cigna's provider portal with genetic testing confirming

The Complete Guide to Getting Kuvan (Sapropterin) Covered by Blue Cross Blue Shield in Ohio: Requirements, Forms, and Appeals

Answer Box: Getting Kuvan Covered in Ohio Blue Cross Blue Shield Ohio (Anthem) requires prior authorization for Kuvan (sapropterin dihydrochloride) with specific clinical documentation. To get approval: (1) Ensure your metabolic specialist submits a complete PA form with recent blood phenylalanine levels >360 µmol/L and proof of dietary

How to Get Strensiq (asfotase alfa) Covered by Aetna CVS Health in North Carolina: Appeals Guide & Templates

Answer Box: Getting Strensiq Covered by Aetna CVS Health in North Carolina Aetna CVS Health covers Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia with prior authorization. Key requirements: ALPL gene mutation OR low alkaline phosphatase plus elevated substrates, proof of onset before age 18, and specialist prescription. If denied, you have

Getting Trikafta Renewed with Humana in New Jersey: Timeline, Documentation, and Appeals Guide

Answer Box: Renewing Trikafta with Humana in New Jersey Humana Medicare Advantage requires Trikafta (elexacaftor/tezacaftor/ivacaftor) renewal every 6-12 months with updated clinical documentation. Submit renewal requests 2-4 weeks before expiration with current liver function tests, pulmonary function data (if age ≥6), and prescriber attestation of continued benefit. If

How to Get Pomalyst (Pomalidomide) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide and Appeals Process

Answer Box: Getting Pomalyst Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Pomalyst (pomalidomide) with strict step therapy requirements. To get approved, you need documented failure of at least one immunomodulatory agent (like lenalidomide), proteasome inhibitor, or anti-CD38 therapy, plus complete REMS program enrollment. First step today: Have

How to Get Evkeeza (Evinacumab) Covered by UnitedHealthcare in Michigan: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Evkeeza Covered by UnitedHealthcare in Michigan Evkeeza (evinacumab) requires prior authorization from UnitedHealthcare through OptumRx, typically with step therapy requirements. For homozygous familial hypercholesterolemia (HoFH) patients in Michigan, the fastest path involves: 1) Having your specialist submit a PA request with genetic confirmation and documented failures of