Counterforce Health Team

How to Get Rinvoq (Upadacitinib) Covered by Humana in California: Appeals Guide, Forms & State Protections

Answer Box: Getting Rinvoq Covered by Humana in California Rinvoq (upadacitinib) requires prior authorization from Humana in California, with typical denials for step therapy requirements or insufficient medical necessity documentation. Your fastest path to approval: 1. Verify coverage: Check Humana's formulary at humana.com/medicare/part-d-drug-plans for your

How to Get Venclexta (venetoclax) Covered by Blue Cross Blue Shield in New York: Complete PA Guide and Appeal Process

Quick Answer: Getting Venclexta Covered in New York Blue Cross Blue Shield of New York requires prior authorization for Venclexta (venetoclax), typically with step therapy requirements for BTK inhibitors like ibrutinib in CLL cases. Three-step path: (1) Your oncologist submits PA via Availity Essentials with diagnosis, TLS monitoring plan, and

How to Get Retevmo (Selpercatinib) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Retevmo Covered by Blue Cross Blue Shield in New York Retevmo (selpercatinib) requires prior authorization from Blue Cross Blue Shield in New York for RET fusion-positive NSCLC and RET-mutant thyroid cancers. The fastest path to approval: (1) Confirm RET testing with an FDA-approved companion diagnostic, (2) Submit

How to Get Vitrakvi (larotrectinib) Covered by Cigna in Florida: Complete PA Guide and Appeal Process

Answer Box: Getting Vitrakvi Covered by Cigna in Florida Cigna requires prior authorization for Vitrakvi (larotrectinib) with NTRK fusion confirmation via molecular testing, oncologist prescription, and documentation of metastatic/unresectable disease. Submit through CoverMyMeds or fax to 866-873-8279 using Florida Medical PA Form. Standard approval takes 72 hours; appeals must

How to Get Orfadin (nitisinone) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Orfadin Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield plans in California require prior authorization for Orfadin (nitisinone) as a specialty drug, with coverage limited to confirmed hereditary tyrosinemia type 1 (HT-1) at doses ≤2 mg/kg per day. Your fastest path to

How to Get Jakafi (Ruxolitinib) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Jakafi Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Jakafi (ruxolitinib) as a Tier 6 specialty medication. For myelofibrosis, you need intermediate/high-risk classification (DIPSS score ≥1) or symptomatic splenomegaly with anemia. For polycythemia vera, you must document hydroxyurea failure, inadequate response, or intolerance first.

How to Get Vitrakvi (Larotrectinib) Covered by Blue Cross Blue Shield in Ohio: Timeline, Appeals, and NTRK Testing Requirements

Quick Answer: Getting Vitrakvi Covered in Ohio Blue Cross Blue Shield in Ohio typically requires prior authorization for Vitrakvi (larotrectinib), with 15 business days for standard review or 72 hours for expedited cases. Success depends on complete NTRK fusion testing documentation, proof of metastatic/unresectable disease, and evidence of failed

How to Get Alecensa (Alectinib) Covered by UnitedHealthcare in Illinois: Complete PA Guide, Forms & Appeals

Answer Box: Getting Alecensa Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization (PA) for Alecensa (alectinib) in Illinois through OptumRx, but typically does not require step therapy for first-line ALK-positive NSCLC treatment. Submit the Illinois Uniform Electronic Prior Authorization Form (Form 3643) with ALK test results, staging, and medical

How to Get Opzelura (ruxolitinib cream) Covered by UnitedHealthcare in Washington: Complete Appeals Guide with Forms and Timelines

Getting Opzelura (ruxolitinib cream) covered by UnitedHealthcare in Washington requires prior authorization with documented failure of topical steroids and calcineurin inhibitors. Submit the OptumRx prior authorization form through the provider portal with clinical documentation. If denied, you have 180 days for internal appeals and can request external review through Washington&

Do You Qualify for Ofev (nintedanib) Coverage by Aetna (CVS Health) in Washington? Decision Tree & Next Steps

Answer Box: Your Path to Ofev (nintedanib) Coverage If you have IPF, SSc-ILD, or progressive fibrosing ILD diagnosed by a pulmonologist with HRCT evidence, you likely qualify for Ofev coverage by Aetna (CVS Health). Required: pulmonologist prescription, HRCT showing fibrosis, recent PFTs (FVC ≥50% predicted, DLCO ≥30%), and baseline liver