Counterforce Health Team

How to Get Evkeeza (evinacumab-dgnb) Covered by Humana in Michigan: Prior Authorization Forms, Appeal Timelines & Scripts

Quick Answer: Getting Evkeeza Covered by Humana in Michigan Evkeeza (evinacumab-dgnb) requires prior authorization from Humana and is covered under your medical benefit, not pharmacy benefit, since it's given by IV infusion. Your fastest path to approval: 1) Confirm HoFH diagnosis with genetic testing or clinical criteria, 2)

How to Get Alprolix Covered by Blue Cross Blue Shield in Pennsylvania: PA Forms, Appeals & Success Strategies

Answer Box: Getting Alprolix Covered by BCBS in Pennsylvania Alprolix requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. The fastest path to approval: (1) Have your hematologist submit a PA request through the BCBS provider portal with documentation of hemophilia B diagnosis, factor IX levels <

How to Get Isturisa (Osilodrostat) Covered by UnitedHealthcare in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Isturisa Covered by UnitedHealthcare in Ohio Fastest path to approval: UnitedHealthcare requires prior authorization for Isturisa (osilodrostat) with documented Cushing's disease and proof that surgery isn't an option or wasn't curative. No step therapy is required if these criteria are met.

Getting Pombiliti (Cipaglucosidase Alfa) Covered by Cigna in Pennsylvania: Prior Authorization, Appeals, and Cost-Saving Strategies

Quick Answer: Getting Pombiliti Covered by Cigna in Pennsylvania Cigna requires prior authorization for Pombiliti (cipaglucosidase alfa-atga) and places it on Tier 5 specialty formulary. First step: Have your prescriber submit PA through CoverMyMeds or ExpressPAth with genetic confirmation of Pompe disease and documentation that you're not improving

Getting Hetlioz (Tasimelteon) Covered by Cigna in Ohio: Complete PA Guide and Appeals Process

Quick Answer: Getting Hetlioz (Tasimelteon) Covered by Cigna in Ohio Cigna requires prior authorization for Hetlioz (tasimelteon) for both Non-24-Hour Sleep-Wake Disorder and Smith-Magenis Syndrome. The fastest path to approval: (1) Ensure your sleep specialist documents diagnosis with ICD-10 code G47.24, (2) Complete step therapy with ramelteon and a

How to Get Ibrance (palbociclib) Covered by Aetna CVS Health in Virginia: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Ibrance Covered by Aetna CVS Health in Virginia Ibrance (palbociclib) requires prior authorization from Aetna CVS Health and is typically covered as a Tier 4 specialty drug with $0 copay after deductible (thanks to Virginia's oral anti-cancer drug parity law). Your oncologist must submit clinical

Myths vs. Facts: Getting Mepsevii (vestronidase alfa-vjbk) Covered by Aetna (CVS Health) in New Jersey

Answer Box: Getting Mepsevii Covered by Aetna in New Jersey To get Mepsevii (vestronidase alfa-vjbk) covered by Aetna (CVS Health) in New Jersey, you need: (1) confirmed MPS VII diagnosis via enzyme assay and genetic testing, (2) elevated urinary GAG levels (2-fold above normal), and (3) prescription from a metabolic

Lowering Out-of-Pocket Costs for Vyndaqel/Vyndamax (Tafamidis) with Blue Cross Blue Shield in Ohio: Complete Coverage Guide

Quick Answer: Getting Vyndaqel/Vyndamax Covered in Ohio Blue Cross Blue Shield plans in Ohio require prior authorization for tafamidis (Vyndaqel/Vyndamax) and typically place it on specialty tiers. Your fastest path to approval: 1) Confirm your ATTR-CM diagnosis with cardiac biopsy or PYP scan, 2) Have your cardiologist submit

How to Get Kalydeco (ivacaftor) Approved by Humana in California: Timeline, Appeals, and Documentation Guide

Answer Box: Getting Kalydeco (ivacaftor) Covered by Humana in California Fastest path to approval: Submit prior authorization with CFTR genotype testing, specialist consultation, and diagnosis confirmation. Humana typically responds within 72 hours for standard requests, 24 hours for expedited. If denied, you have 65 days to appeal and can request

Getting Strimvelis Gene Therapy Covered by Aetna in Georgia: Complete Guide to Forms, Appeals, and Approval

Quick Answer: Getting Strimvelis Covered by Aetna in Georgia Strimvelis (autologous CD34+ ADA-SCID gene therapy) requires prior authorization from Aetna. Since it's only available at SR-TIGET in Milan, Italy, you'll need out-of-network coverage approval. Start by having your doctor submit a prior authorization request with genetic