Counterforce Health Team

Do You Qualify for Elfabrio Coverage by UnitedHealthcare in Michigan? Decision Tree & Next Steps

Quick Answer: Your Path to Elfabrio Coverage If you have confirmed Fabry disease and UnitedHealthcare in Michigan: You'll need prior authorization through OptumRx. Start with genetic testing confirmation (GLA mutation) and enzyme levels. Most patients must try Galafold or Fabrazyme first due to step therapy. If denied, Michigan

The Complete Checklist to Get Crysvita (Burosumab) Covered by Cigna in California: Forms, Appeals, and Requirements

Answer Box: Fastest Path to Approval Getting Crysvita (burosumab) covered by Cigna in California requires prior authorization through Express Scripts/Accredo with specific documentation: confirmed XLH diagnosis (PHEX gene mutation or elevated FGF23), baseline low serum phosphorus, endocrinologist prescription, and failed oral phosphate therapy. First step today: Have your specialist

How to Get Givlaari (Givosiran) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Givlaari Covered by Cigna in North Carolina To get Givlaari (givosiran) approved by Cigna in North Carolina, you need: (1) Confirmed acute hepatic porphyria with elevated ALA/PBG levels or genetic testing, (2) Documentation of ≥2 attacks in 6 months requiring hospitalization/hemin, and (3) Prescription by

Work With Your Doctor to Get Nucala (Mepolizumab) Approved by UnitedHealthcare in Virginia: Complete Guide

Answer Box: Getting Nucala Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Nucala (mepolizumab) through OptumRx, with approval based on severe eosinophilic asthma criteria including blood eosinophil count ≥150 cells/μL and poor asthma control despite optimized therapy. Your fastest path: (1) Schedule a visit to document current

How Long Does It Take to Get Therakos CELLEX Photopheresis Approved by UnitedHealthcare in Florida? Timeline & Appeal Guide

Answer Box: Getting Therakos CELLEX Covered by UnitedHealthcare in Florida Therakos CELLEX photopheresis requires prior authorization from UnitedHealthcare in Florida, typically taking 7-10 business days for initial review. Submit through the UnitedHealthcare Provider Portal with complete clinical documentation including diagnosis (CTCL/GVHD), steroid-refractory evidence, and specialist oversight. If denied, you

Myths vs. Facts: Getting Helixate (Antihemophilic Factor rFVIII) Covered by UnitedHealthcare in Pennsylvania

Quick Answer: Helixate Coverage by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Helixate (antihemophilic factor rFVIII) in Pennsylvania, but coverage is available for confirmed hemophilia A patients. Submit requests via the UHC Provider Portal or call OptumRx at 866-889-8054 with diagnosis documentation (ICD-10 D66), factor VIII levels, and bleeding

How Long Does It Take to Get Cabometyx (Cabozantinib) Approved by Aetna CVS Health in Pennsylvania? Complete Timeline Guide

Answer Box: Cabometyx (Cabozantinib) Approval Timeline for Aetna CVS Health in Pennsylvania Cabometyx requires a formulary exception from Aetna CVS Health (excluded from Advanced Control formulary), taking 30-45 days for standard review or 72 hours for expedited cases. Pennsylvania residents benefit from a state external review program with 53% success

How to Get Hetlioz LQ (Tasimelteon) Covered by Humana in Illinois: Appeals Guide & Templates

Answer Box: Getting Hetlioz LQ Covered by Humana in Illinois Humana requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) in Illinois. The fastest path to approval: Submit PA request with confirmed Smith-Magenis syndrome diagnosis, genetic testing results, failed sleep hygiene/melatonin trials, and pediatric weight-based dosing justification. If denied,

How to Get Strensiq (asfotase alfa) Covered by Humana in Washington: Prior Authorization Guide with Appeals Process

Answer Box: Getting Strensiq (asfotase alfa) Covered by Humana in Washington Strensiq (asfotase alfa) requires prior authorization from Humana and is likely non-formulary for most Medicare Advantage plans in Washington. Your fastest path: (1) Have your prescriber submit a formulary exception request with medical necessity documentation to Humana Clinical Pharmacy

Get Cabometyx (Cabozantinib) Covered by Aetna in Michigan: Complete PA Guide and Appeals Process

Answer Box: Getting Cabometyx Covered by Aetna in Michigan Cabometyx (cabozantinib) requires prior authorization from Aetna CVS Health for all FDA-approved cancer indications in Michigan. The fastest path to approval: (1) Submit complete PA documentation through your oncologist including prior therapy failures and recent imaging, (2) Use Aetna's