Counterforce Health Team

How to Get Soliris (Eculizumab) Covered by Cigna in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Soliris Covered by Cigna in California Cigna requires prior authorization for Soliris (eculizumab) across all FDA-approved indications in California. The fastest path to approval: (1) Ensure meningococcal vaccinations are completed ≥2 weeks before treatment, (2) Have your specialist submit the PA through Cigna's provider portal

How to Get Tavneos (Avacopan) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tavneos (Avacopan) Covered by Humana in New Jersey Tavneos (avacopan) requires prior authorization from Humana for ANCA-associated vasculitis coverage. Your rheumatologist, nephrologist, or pulmonologist must submit documentation proving severe active GPA/MPA with positive ANCA testing, combination with standard therapy, and medical necessity. First step today: Have

How to Get Pyrukynd (Mitapivat) Covered by Humana in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pyrukynd Covered by Humana in Michigan Humana requires prior authorization for Pyrukynd (mitapivat) with genetic confirmation of pyruvate kinase deficiency, prescription by a hematologist, and documented clinical severity. If denied, you have 65 days to file a Humana redetermination, then 127 days for Michigan DIFS external review.

How to Get Soliris (Eculizumab) Covered by Cigna in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Your Fastest Path to Soliris Coverage Cigna requires prior authorization for Soliris (eculizumab) in Illinois based on FDA-approved indications with specific diagnostic testing. Submit through CoverMyMeds or provider portal with specialist evaluation, required labs (flow cytometry for PNH, anti-AChR antibodies for myasthenia gravis), meningococcal vaccination proof, and REMS

How to Get Brineura (Cerliponase Alfa) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Brineura Covered by Blue Cross Blue Shield in Pennsylvania Brineura (cerliponase alfa) requires prior authorization from Blue Cross Blue Shield plans in Pennsylvania, including Highmark and Independence Blue Cross. Coverage is approved for pediatric patients with confirmed CLN2 disease (TPP1 deficiency) when administered at specialized centers by

How to Get Orfadin (nitisinone) Covered by Humana in Michigan: Prior Authorization Guide and Appeal Process

Answer Box: Getting Orfadin (nitisinone) Covered by Humana in Michigan Orfadin (nitisinone) is likely non-formulary on Humana Medicare Advantage plans, requiring a formulary exception request with medical necessity documentation for hereditary tyrosinemia type 1 (HT-1). First step: Have your prescriber submit a prior authorization through Humana's provider portal

How to Get Qinlock (Ripretinib) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization and Appeals Guide

Quick Answer: Qinlock (ripretinib) requires prior authorization from Aetna CVS Health in Pennsylvania. You'll need documented failure of three prior kinase inhibitors (imatinib, sunitinib, regorafenib), submit through the CVS Caremark portal or CoverMyMeds, and allow 15 business days for standard review. If denied, Pennsylvania's new external

Renewing Retevmo (Selpercatinib) Approval with Cigna in Virginia: Complete Renewal Guide and Timeline

Answer Box: Retevmo (Selpercatinib) Renewal with Cigna in Virginia Cigna requires prior authorization renewal for Retevmo (selpercatinib) every 12 months through Express Scripts/Accredo specialty pharmacy. Start your renewal 30-45 days before expiration with updated RET testing confirmation, disease status imaging, treatment response documentation, and an oncologist necessity letter citing

How to Get Blenrep (belantamab mafodotin) Covered by Cigna in Texas: Forms, Appeals, and Current Access Options

Answer Box: Getting Blenrep (belantamab mafodotin) Covered by Cigna in Texas Current Status: Blenrep is not commercially available in the US (withdrawn 2022; FDA resubmission pending October 2025). For Texas patients with Cigna coverage, access is limited to clinical trials or expanded access programs. If pursuing coverage: Submit Cigna'

Get Gattex (Teduglutide) Covered by UnitedHealthcare in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gattex Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Gattex (teduglutide) with documentation of short bowel syndrome, parenteral nutrition dependence ≥3 days/week for 12+ months, and failed enteral nutrition optimization. Submit through the UnitedHealthcare Provider Portal with gastroenterologist attestation. If denied, you have 180