Counterforce Health Team

How to Get Bylvay (odevixibat) Covered by Aetna (CVS Health) in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Bylvay (odevixibat) Covered by Aetna (CVS Health) in New York Bylvay (odevixibat) requires prior authorization from Aetna (CVS Health) and is typically non-formulary, requiring a medical exception. The fastest path: Have a pediatric hepatologist or gastroenterologist submit a complete PA packet through Aetna's provider portal

How to Get Rapivab (Peramivir) Covered by Blue Cross Blue Shield in North Carolina: Appeals, Forms, and State Protections

Answer Box: Getting Rapivab Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Rapivab (peramivir), listed under "Prior Review" in their 2024-2025 formularies. To get approval: (1) Submit a PA request via the BCBS NC provider portal

Getting Blenrep (Belantamab Mafodotin) Covered by UnitedHealthcare in Illinois: PA Requirements, Appeals, and Cost Support

Answer Box: Getting Blenrep Covered by UnitedHealthcare in Illinois Important Update: Blenrep (belantamab mafodotin) was voluntarily withdrawn from the U.S. market in 2022. GSK resubmitted for FDA approval with a PDUFA date of October 23, 2025. Currently, access is limited to clinical trials or expanded access programs only. For

Aetna (CVS Health) Coverage Criteria for Ultomiris (ravulizumab) in New York: What Counts as "Medically Necessary"?

Answer Box: Getting Ultomiris Covered by Aetna (CVS Health) in New York Ultomiris (ravulizumab) requires prior authorization from Aetna (CVS Health) for all FDA-approved indications (PNH, aHUS, anti-AChR+ generalized myasthenia gravis, and NMOSD). Coverage requires meeting diagnosis-specific criteria, meningococcal vaccination, and documentation of clinical necessity. Quick start: 1) Verify your

How to Get Opdivo (Nivolumab) Covered by Aetna (CVS Health) in Washington: Complete Prior Authorization Guide

Answer Box: Getting Opdivo Covered by Aetna (CVS Health) in Washington Opdivo (nivolumab) requires prior authorization from Aetna (CVS Health) for all oncology indications in Washington. The fastest path to approval: 1) Verify if your plan uses medical or specialty pharmacy benefit, 2) Complete the Opdivo Injectable Medication Precertification Request

Renewing Onpattro (Patisiran) Coverage with Humana in Washington: Complete Timeline & Documentation Guide

Answer Box: Renewing Onpattro (Patisiran) with Humana in Washington Start your renewal process 4-6 weeks before your current authorization expires. Humana typically requires updated mNIS+7 scores, 6-minute walk test results, and neurologist documentation showing stabilization or improvement versus baseline. Submit via Humana's provider portal with complete clinical

Renewing Kuvan (Sapropterin) Approval with UnitedHealthcare in Washington: 2025 Requirements & Timeline

Answer Box: Kuvan Renewal Requirements UnitedHealthcare requires annual prior authorization renewal for Kuvan (sapropterin) with specific documentation: active phenylalanine-restricted diet, sustained blood Phe reduction from baseline (typically ≥20-30%), and confirmation you're not using concurrent Palynziq therapy. Start renewal 60-90 days before expiration. Submit through the UnitedHealthcare Provider Portal

How to Get Cometriq (cabozantinib) Covered by Cigna in Texas: Complete Cost-Saving and Appeals Guide

Answer Box: Cometriq (cabozantinib capsules) requires prior authorization from Cigna in Texas, typically approved for medullary thyroid carcinoma patients ≥18 years old through their specialty pharmacy network (Accredo). Start by having your oncologist submit a PA request via Cigna's provider portal with your MTC diagnosis (ICD-10 C73), progressive

How to Get Cometriq (cabozantinib) Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cometriq Covered in Texas Blue Cross Blue Shield of Texas (BCBSTX) covers Cometriq (cabozantinib) capsules for metastatic medullary thyroid carcinoma with prior authorization. The fastest path to approval: (1) Confirm your exact BCBSTX plan and verify Cometriq is on your formulary with PA status, (2) Have your

How Long Does It Take to Get Arikayce Approved by UnitedHealthcare in Pennsylvania? Complete Timeline Guide

Answer Box: Getting Arikayce Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Arikayce (amikacin liposome inhalation) with a standard review timeline of 7-14 days from complete submission. To qualify, you must have refractory MAC lung disease with positive cultures after ≥6 months of failed combination therapy (macrolide + ethambutol