Counterforce Health Team

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

Getting Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in California: Complete Coding, Appeals, and Authorization Guide

Quick Answer: Getting Strimvelis Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield plans in California require prior authorization for Strimvelis (autologous CD34+ gene therapy for ADA-SCID), administered only at SR-TIGET in Milan, Italy. Use ICD-10 code D81.31 (severe combined immunodeficiency due to adenosine deaminase deficiency)

How to Get Abecma (Idecabtagene Vicleucel) Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Abecma Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Abecma (idecabtagene vicleucel) under their CAR-T therapy transplant guidelines. Eligibility requires ≥2 prior lines including an IMiD, proteasome inhibitor, and anti-CD38 antibody, plus treatment at a UHC-designated center. First step: Submit PA via UHC Provider Portal

How to Get Blenrep (belantamab mafodotin) Covered by Aetna (CVS Health) in Pennsylvania: Appeals Guide with Forms and Timelines

Answer Box: Getting Blenrep Covered in Pennsylvania Blenrep (belantamab mafodotin) received FDA approval on October 23, 2025, for adults with relapsed or refractory multiple myeloma. Aetna (CVS Health) requires prior authorization through CVS Caremark for this specialty drug. If denied, Pennsylvania's external review program overturns approximately 50% of

How to Get Mycapssa (Octreotide Oral) Covered by Cigna in Illinois: Complete PA Forms, Appeals, and Timelines Guide

Answer Box: Getting Mycapssa Covered by Cigna in Illinois Mycapssa (oral octreotide) requires prior authorization from Cigna for acromegaly maintenance in adults who responded to injectable octreotide or lanreotide. Submit PA via CoverMyMeds (2-3 business days) with IGF-1 labs above normal, documentation of prior injectable response, and endocrinologist consultation. If

The Requirements Checklist to Get Vimizim (Elosulfase Alfa) Covered by Cigna in Florida

Quick Answer: Getting Vimizim Covered by Cigna in Florida Cigna requires prior authorization for Vimizim (elosulfase alfa) in Florida patients with MPS IVA. The fastest path to approval: (1) Confirm GALNS enzyme deficiency with documented testing, (2) Submit Cigna's Vimizim PA form with baseline functional assessments, and (3)

How Long Does It Take to Get Opzelura (Ruxolitinib Cream) Approved by UnitedHealthcare in Texas? Complete Timeline Guide

Quick Answer: Opzelura Approval Timeline in Texas UnitedHealthcare requires prior authorization for Opzelura (ruxolitinib cream) in Texas, with approval typically taking 7-14 days once complete documentation is submitted. You must demonstrate failure of topical steroids and calcineurin inhibitors first. If denied, you have 60 days to appeal internally (30-day response)

How to Get Idelvion Covered by Aetna CVS Health in New Jersey: Prior Authorization Guide and Appeals Process

Answer Box: Getting Idelvion Covered by Aetna CVS Health in New Jersey Idelvion (albutrepenonacog alfa; rFIX-FP) requires prior authorization from Aetna CVS Health for hemophilia B treatment. Key requirements: confirmed Factor IX deficiency ≤2%, negative inhibitors (<0.6 BU), board-certified hematologist prescription, and specialty pharmacy dispensing through CVS Caremark.