Counterforce Health Team

How to Get Tegsedi (inotersen) Covered by Cigna in California: Complete Guide with Forms, Appeals, and IMR Process

Answer Box: Your Fastest Path to Tegsedi Coverage Tegsedi (inotersen) requires prior authorization through Cigna in California. Your prescriber must submit a PA request via the EviCore portal or call 1-800-882-4462 with genetic testing confirmation, REMS enrollment proof, and specialist prescription. If denied, file an internal appeal within 180 days,

How to Get Berinert (C1-esterase inhibitor, IV) Covered by UnitedHealthcare in New York: Complete Guide with Forms, Appeals, and Support Resources

Answer Box: Quick Path to Berinert Coverage To get Berinert (C1-esterase inhibitor, IV) covered by UnitedHealthcare in New York: Submit prior authorization through OptumRx with confirmed HAE diagnosis (C1-INH deficiency labs or genetic variants), prescribed by immunologist/allergist for acute attacks only. Use CoverMyMeds for electronic PA or fax to

Lowering Out-of-Pocket Costs for Amondys 45 with UnitedHealthcare in Florida: Copay Cards, Appeals, and Financial Assistance

Quick Answer: Getting Amondys 45 Covered and Affordable UnitedHealthcare requires prior authorization for Amondys 45 (casimersen), with costs potentially reaching thousands monthly without proper coverage. In Florida, you have three main cost-reduction paths: (1) Ensure proper PA approval with genetic testing proof and functional assessments, (2) Apply for Sarepta'

How Long Does It Take to Get Tavalisse Approved by UnitedHealthcare in New York? Complete Timeline & Appeals Guide

Answer Box: Getting Tavalisse Covered by UnitedHealthcare in New York UnitedHealthcare typically processes Tavalisse (fostamatinib) prior authorizations within 24 hours for standard submissions, or within minutes for electronic requests through OptumRx. The fastest path requires your hematologist to submit complete documentation showing failed prior therapies (steroids, IVIG, or TPO agonists)

Do You Qualify for Amvuttra (vutrisiran) Coverage by UnitedHealthcare in Texas? Decision Tree & Next Steps

Answer Box: Fastest Path to Amvuttra Coverage in Texas You likely qualify if you have confirmed hATTR amyloidosis (genetic testing or biopsy), polyneuropathy stage PND ≤ IIIb or ATTR cardiomyopathy, and a specialist prescription. UnitedHealthcare requires prior authorization through OptumRx specialty pharmacy. Start today: Call member services (number on your insurance

How to Get Chenodal (Chenodiol) Covered by Cigna in Illinois: Complete PA Guide with Appeals Process

Answer Box: Getting Chenodal (Chenodiol) Covered by Cigna in Illinois Cigna requires prior authorization for Chenodal (chenodiol) with approval for 1 year if you meet medical criteria. You need radiolucent gallstones confirmed on imaging, surgical ineligibility documentation, and either failed ursodiol therapy or contraindications. Your doctor submits the PA request

How to Get Amondys 45 (casimersen) Covered by UnitedHealthcare in North Carolina: Complete PA Guide and Appeal Scripts

Answer Box: Getting Amondys 45 Covered by UnitedHealthcare in North Carolina Amondys 45 (casimersen) requires prior authorization from UnitedHealthcare, with genetic testing confirming DMD amenable to exon 45 skipping as the primary requirement. Submit PA through OptumRx with complete genetic documentation, specialist records, and infusion plan. If denied, appeal within

How to Get Palynziq (pegvaliase-pqpz) Covered by Humana in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Palynziq Covered by Humana in Ohio Humana requires prior authorization for Palynziq (pegvaliase-pqpz) in Ohio, with coverage typically needing confirmed PKU diagnosis, blood phenylalanine >600 µmol/L despite diet optimization, failed sapropterin trial, age ≥18, and REMS enrollment. Submit PA through Humana provider portal with complete

How to Get Oxlumo (Lumasiran) Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Oxlumo Coverage To get Oxlumo (lumasiran) covered by Aetna CVS Health in New Jersey: Submit prior authorization with confirmed PH1 diagnosis (genetic AGXT testing or liver enzyme analysis), specialist prescription from nephrologist/geneticist, baseline eGFR ≥30 mL/min/1.73m², and urinary oxalate levels. Use

Myths vs. Facts: Getting Sumavel DosePro Covered by Cigna in Illinois (Appeals Guide + Forms)

Answer Box: Getting Sumavel DosePro Covered by Cigna in Illinois Important Update: Sumavel DosePro (needle-free sumatriptan injection) has been discontinued in the U.S. However, similar injectable triptans follow the same approval process outlined here. Cigna requires prior authorization for injectable sumatripans with mandatory step therapy—you must try and