Counterforce Health Team

Lowering Out-of-Pocket for Firazyr (icatibant injection) with Aetna (CVS Health) in Texas: Copay Cards, Financial Assistance & Appeal Strategies

Answer Box: Getting Firazyr Covered by Aetna (CVS Health) in Texas Aetna covers Firazyr (icatibant injection) for acute HAE attacks when prescribed by an HAE specialist, with potential costs ranging from $5-$11,147 per dose depending on your plan design and assistance eligibility. Commercial insurance patients can access Takeda&

How to Get Arikayce (Amikacin Liposome Inhalation) Covered by Aetna CVS Health in Washington: Prior Authorization Forms, Appeals, and Timelines

Answer Box: Getting Arikayce Covered by Aetna CVS Health in Washington Arikayce (amikacin liposome inhalation) requires prior authorization from Aetna CVS Health for refractory MAC lung disease. You need 6+ months of failed multidrug therapy, positive MAC cultures, and specialist involvement. Submit via Availity portal with medical necessity letter, culture

How to Get Opdivo (Nivolumab) Covered by Humana in Texas: Complete Prior Authorization Guide

Answer Box: Getting Opdivo (Nivolumab) Covered by Humana in Texas Opdivo requires prior authorization for all Humana Medicare Advantage plans in Texas. Your oncologist must submit documentation including pathology reports, biomarker testing, and prior treatment history through Humana's provider portal or by fax to 877-486-2621. Standard decisions take

How to Get Turalio (Pexidartinib) Covered by UnitedHealthcare in Ohio: Complete PA and Appeals Guide

Answer Box: Getting Turalio Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Turalio (pexidartinib) with TGCT diagnosis confirmation, REMS enrollment, and surgical non-feasibility documentation. The fastest path: (1) Complete TURALIO REMS enrollment at turaliorems.com (3-5 days), (2) Gather pathology, imaging, and surgical consult notes, (3) Submit PA

How to Get Kanuma (Sebelipase Alfa) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Kanuma Covered by Aetna CVS Health in California Kanuma (sebelipase alfa) requires prior authorization from Aetna CVS Health. To get approved in California: 1) Have your doctor submit a PA request with LAL-D diagnosis confirmation (enzyme testing or genetic results), clinical evidence of disease severity, and dosing

Getting Elzonris (Tagraxofusp-erzs) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization Guide with Appeals

Answer Box: How to Get Elzonris Covered by UnitedHealthcare in Illinois Elzonris requires prior authorization from UnitedHealthcare, typically approved when patients have confirmed CD123-positive BPDCN diagnosis with baseline albumin ≥3.2 g/dL and capillary leak syndrome monitoring plan. The fastest path: (1) Gather pathology report showing CD123-positive BPDCN, recent

How to Get Soliris (Eculizumab) Covered by Cigna in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Soliris (Eculizumab) Covered by Cigna in Virginia Cigna requires prior authorization for Soliris (eculizumab) with specific diagnostic tests and vaccination requirements. The fastest path: (1) Confirm your diagnosis meets FDA criteria with required lab tests, (2) Complete meningococcal vaccinations ≥2 weeks before treatment, (3) Submit PA through

Myths vs. Facts: Getting Krystexxa (Pegloticase) Covered by Humana in North Carolina

Answer Box: Getting Krystexxa Covered by Humana in North Carolina Yes, Humana covers Krystexxa (pegloticase) with prior authorization. Key requirements: chronic gout diagnosis, failed allopurinol (≥300mg/day for 3+ months) plus uricosuric therapy, negative G6PD screen, rheumatologist prescription, and serum uric acid ≥6 mg/dL. Submit requests through Humana'

Lowering Out-of-Pocket Costs for Onivyde with UnitedHealthcare in Illinois: Copay Cards, Tier Exceptions & Appeals

Quick Answer: Getting Onivyde Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Onivyde (irinotecan liposome) through OptumRx with step therapy requirements. Submit PA documentation including ECOG performance status 0-1, adequate organ function labs, diagnosis confirmation, and either first-line NALIRIFOX eligibility or prior gemcitabine failure. If denied, you have

Work With Your Doctor to Get Cystadane (Betaine Anhydrous) Approved by Blue Cross Blue Shield in Washington: Complete Provider Collaboration Guide

Answer Box: Getting Cystadane Covered Through Provider Partnership Blue Cross Blue Shield requires prior authorization for Cystadane with genetic confirmation, vitamin therapy trials, and specialist involvement. Success depends on strong provider collaboration: gather genetic testing results and homocysteine labs (>100 μmol/L), document failed vitamin B6/B12/folate trials,