Counterforce Health Team

Getting Strimvelis Gene Therapy Covered by Humana in Virginia: Complete Timeline, Forms, and Appeals Guide

Answer Box: Fast Track to Strimvelis Coverage Getting Strimvelis covered by Humana in Virginia requires prior authorization with documented ADA enzyme deficiency (<1% normal), genetic confirmation of bi-allelic ADA mutations, and proof no suitable bone marrow donor exists. Submit via Humana's Clinical Pharmacy Review (800-555-2546) with medical

How to Get Aldurazyme (Laronidase) Covered by Humana in Florida: Complete PA Guide with Forms and Appeals

Answer Box: Getting Aldurazyme Covered by Humana in Florida Aldurazyme (laronidase) requires prior authorization from Humana and is covered as a Medicare Part B medical benefit. Your MPS I specialist must submit genetic testing, enzyme assay results, and a detailed treatment plan. Standard approval takes up to 30 days; expedited

How to Get Orladeyo (Berotralstat) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Orladeyo Covered by Blue Cross Blue Shield in New Jersey Horizon Blue Cross Blue Shield of New Jersey requires prior authorization for Orladeyo (berotralstat), a specialty-tier drug for HAE prophylaxis in patients ≥12 years old. The fastest path to approval: (1) Have your allergist/immunologist submit prior

Getting Zanzalintinib (XL092) Covered by UnitedHealthcare in Pennsylvania: Clinical Trial Access and Compassionate Use Appeals Guide

Answer Box: Your Fastest Path to Zanzalintinib Coverage Getting Zanzalintinib (XL092) covered by UnitedHealthcare in Pennsylvania requires clinical trial enrollment or compassionate use approval, since this investigational TKI has no FDA approval. Your three options: (1) Enroll in an active STELLAR program trial where UnitedHealthcare covers routine monitoring costs, (2)

How to Get Fintepla (fenfluramine) Covered by Blue Cross Blue Shield in Washington: Appeals Process, REMS Requirements, and State Protections

Answer Box: Getting Fintepla Covered by Blue Cross Blue Shield in Washington Fintepla (fenfluramine) requires prior authorization from Blue Cross Blue Shield with mandatory REMS enrollment and baseline echocardiography. To get approval: (1) Complete REMS enrollment at FinteplaREMS.com with baseline ECHO, (2) Submit PA with diagnosis confirmation (Dravet G40.

How to Get Rezlidhia (Olutasidenib) Covered by UnitedHealthcare in New York: Prior Authorization Guide

Answer Box: Getting Rezlidhia Covered by UnitedHealthcare in New York Rezlidhia (olutasidenib) requires prior authorization from UnitedHealthcare OptumRx in New York. You'll need documented IDH1 mutation results, confirmed relapsed/refractory AML diagnosis, and evidence of prior therapy failures. Submit through the UnitedHealthcare Provider Portal with complete documentation for

How to Get Humira (adalimumab) Covered by Aetna (CVS Health) in California: Complete 2025 Guide with Forms and Appeals

Answer Box: Fastest Path to Humira Coverage with Aetna in California Aetna requires prior authorization for Humira (adalimumab) with step therapy to preferred biosimilars first. To get coverage: 1) Submit PA via CVS Caremark ePA portal with specialist prescription, TB/hepatitis B screening, and documented biosimilar failures, 2) If denied,

How to Get Cosentyx (secukinumab) Covered by Blue Cross Blue Shield of Illinois: Complete Coding, PA, and Appeals Guide

Answer Box: Getting Cosentyx Approved in Illinois Cosentyx (secukinumab) requires prior authorization through Blue Cross Blue Shield of Illinois for 2024-2025, using HCPCS code J3247 for IV formulation or J3590 for subcutaneous. Submit PA requests with proper ICD-10 codes (L40.0 for plaque psoriasis, L40.50-59 for psoriatic arthritis), tuberculosis

How to Get Gamifant (Emapalumab-lzsg) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Timeline and Appeal Guide

Answer Box: Getting Gamifant Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield requires prior authorization for Gamifant (emapalumab-lzsg) with documented HLH diagnosis using 5 of 8 HLH-2004 criteria OR genetic confirmation, plus failure/intolerance to conventional therapy (etoposide, dexamethasone, cyclosporine). Standard PA decisions take 14-30 days;

How to Get Tremfya (Guselkumab) Covered by Cigna in Ohio: Complete PA Guide with Appeals and Timeline

Answer Box: Quick Path to Tremfya Coverage Cigna requires prior authorization for Tremfya (guselkumab) in Ohio with mandatory step therapy through TNF inhibitors. Your dermatologist or specialist must submit the PA form with documented failure of at least one TNF inhibitor (like Humira), current TB screening, and disease severity measures.