Counterforce Health Team

Counterforce Health Team

How to Get Tegsedi (Inotersen) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tegsedi (Inotersen) Covered by Aetna CVS Health in Illinois Tegsedi (inotersen) requires prior authorization from Aetna CVS Health for hATTR polyneuropathy coverage in Illinois. Key requirements: confirmed TTR gene mutation, documented polyneuropathy symptoms, specialist prescription (neurologist/geneticist), and REMS program enrollment. Submit via Aetna provider portal with
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How to Get Elzonris (Tagraxofusp-Erzs) Covered by Cigna in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Elzonris Covered by Cigna in Texas Yes, Cigna covers Elzonris (tagraxofusp-erzs) for CD123-positive BPDCN with prior authorization. Your oncologist submits via Cigna/Express Scripts portal with pathology confirming CD123+ immunophenotype, baseline albumin ≥3.2 g/dL, and capillary leak syndrome monitoring plan. Standard review takes 72 hours;
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How to Get Vitrakvi (larotrectinib) Covered by Blue Cross Blue Shield of Illinois: PA Forms, Appeal Scripts & NTRK Testing Requirements

Answer Box: Getting Vitrakvi Covered by BCBS Illinois Blue Cross Blue Shield of Illinois (BCBSIL) requires prior authorization for Vitrakvi (larotrectinib), which is not on their 2025 formulary. Your fastest path to approval: (1) Submit a complete PA request with validated NTRK fusion testing results, (2) Include medical necessity documentation
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How to Get Tavalisse (Fostamatinib) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tavalisse Approved by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Tavalisse (fostamatinib) with strict step therapy criteria including documented failure of corticosteroids, IVIG, and TPO receptor agonists. Your fastest path: Have your hematologist submit a complete PA request via the Aetna provider
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How to Get Mycapssa (Octreotide Oral) Covered by Aetna CVS Health in North Carolina: Appeals, Prior Authorization, and State Protections

Answer Box: Getting Mycapssa Covered by Aetna CVS Health in North Carolina Fastest path to approval: Submit prior authorization through CVS Specialty (1-800-237-2767) with documented acromegaly diagnosis, prior response to injectable octreotide/lanreotide, and medical necessity letter. If denied, file internal appeal within 180 days citing North Carolina step therapy
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