Counterforce Health Team

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

How to Get Blenrep (Belantamab Mafodotin) Covered by Blue Cross Blue Shield in Virginia: Current Access Options and Appeals Guide

Answer Box: Blenrep Coverage in Virginia Blenrep (belantamab mafodotin) is not commercially available in the U.S. as of 2025 due to GSK's voluntary withdrawal in 2022 pending FDA resubmission (PDUFA target October 2025). Current access is limited to clinical trials or expanded access programs only. For Blue

How to Get Dupixent (dupilumab) Covered by Blue Cross Blue Shield in Ohio: Prior Authorization, Appeals, and Step Therapy Override Guide

Answer Box: Getting Dupixent Covered in Ohio Blue Cross Blue Shield (primarily Anthem) in Ohio requires prior authorization for Dupixent (dupilumab) with step therapy requirements varying by indication. Ohio's step therapy override law (ORC §3901.832) requires approval within 72 hours if you've failed preferred treatments

Do You Qualify for Hetlioz LQ Coverage by UnitedHealthcare in New Jersey? Complete Decision Tree & Appeals Guide

Answer Box: Your Fast Track to Hetlioz LQ Coverage To get Hetlioz LQ (tasimelteon oral suspension) covered by UnitedHealthcare in New Jersey: You need genetic confirmation of Smith-Magenis syndrome (17p11.2 deletion or RAI1 mutation), documented melatonin trial failure (typically 4-6 weeks), and prescription by a sleep specialist. Submit prior

Getting Blenrep (Belantamab Mafodotin) Covered by Aetna (CVS Health) in Washington: Complete Access Guide for Current and Future Approval

Answer Box: Current Blenrep Access Through Aetna in Washington Blenrep (belantamab mafodotin) is not commercially available through standard Aetna coverage due to its 2022 FDA withdrawal, with re-approval anticipated October 2025. Current access requires clinical trial enrollment or GSK expanded access programs. Washington residents denied coverage can appeal through Aetna&

Work With Your Doctor to Get Prolastin-C Approved by Cigna in Washington: Provider Collaboration Guide

Answer Box: Your Path to Prolastin-C Coverage Cigna covers Prolastin-C for alpha-1 antitrypsin deficiency with prior authorization requiring: age ≥18, AAT levels <80 mg/dL, lung disease evidence (FEV1 <80% predicted), non-smoking status, and pulmonologist involvement. First step: Schedule a visit with your doctor to document these criteria

How to Get Waylivra (Volanesorsen) Covered by Aetna CVS Health in California: Forms, Appeals, and Success Strategies

Answer Box: Getting Waylivra Covered by Aetna CVS Health in California Waylivra (volanesorsen) requires a medical exception request with Aetna CVS Health since it's not FDA-approved or on standard formularies. California patients must document confirmed familial chylomicronemia syndrome (FCS) via genetic testing, triglycerides >875 mg/dL, and