Counterforce Health Team

How Long Does It Take to Get Helixate (Antihemophilic Factor, rFVIII) Approved by UnitedHealthcare in Michigan? Complete Timeline & Approval Guide

Answer Box: Getting Helixate Approved by UnitedHealthcare in Michigan Important Note: Helixate FS and Kogenate FS were discontinued in 2022-2023. Current patients need alternative factor VIII products like Kovaltry or Jivi, which follow similar approval timelines. Fastest Path: Standard prior authorization takes 15 days, expedited review 72 hours for urgent

Myths vs. Facts: Getting Enbrel (etanercept) Covered by Aetna (CVS Health) in Michigan

Answer Box: The Reality of Enbrel Coverage in Michigan Myth: If your doctor prescribes Enbrel, Aetna (CVS Health) automatically covers it. Fact: Aetna typically requires prior authorization and often step therapy (trying biosimilar alternatives first) for Enbrel in Michigan. Success depends on proper documentation, not just a prescription. Your fastest

How to Get Bylvay (odevixibat) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals, and Alternative Paths

Answer Box: Getting Bylvay Covered by UnitedHealthcare in New York Bylvay (odevixibat) requires prior authorization from UnitedHealthcare in New York. Most plans use either a Notification policy (lighter requirements) or Medical Necessity policy (requires failure of 2+ conventional cholestatic treatments first). If denied, New York offers strong external appeal protections

If Tavneos (Avacopan) Isn't Approved by Cigna in Washington: Formulary Alternatives and Exception Strategies

Answer Box: Quick Start Guide If Cigna denies Tavneos (avacopan) for ANCA-associated vasculitis in Washington, you have three main paths forward: 1) Try formulary alternatives like rituximab or cyclophosphamide that may have easier approval, 2) Request a formulary exception with strong clinical evidence showing why alternatives are inadequate, or 3)

Renewing Waylivra (Volanesorsen) Approval with Humana in North Carolina: Essential Preparation Guide

Quick Answer: Waylivra (volanesorsen) requires annual prior authorization renewal with Humana Medicare Advantage plans. Start the renewal process 30 days before your current approval expires by having your prescriber submit updated clinical documentation showing ongoing medical necessity, treatment response, and safety monitoring. If denied, you have 65 days to appeal

How to Get Breyanzi Covered by Blue Cross Blue Shield of Michigan: Prior Authorization Guide and Appeals Process

Answer Box: Getting Breyanzi Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Breyanzi (lisocabtagene maraleucel) under their medical benefit, with coverage limited to FDA-approved indications after documented failure of prior therapies. Submit requests using the BCBSM Medication Authorization Request Form (fax to 1-877-325-5979), including cardiac

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Humana in New Jersey: Renewal Guide with Appeals Process

Answer Box: Getting Tafamidis Renewal Approved by Humana in New Jersey Eligibility: Humana Medicare Advantage/Part D members in New Jersey need annual prior authorization renewal for tafamidis (Vyndaqel/Vyndamax) with confirmed ATTR-CM diagnosis and cardiology oversight. Fastest path: Submit renewal PA 30-45 days before expiration via Humana provider portal

How to Get Cimzia (Certolizumab Pegol) Covered by Blue Cross Blue Shield in Georgia: Complete PA Guide with Forms and Appeals

Answer Box: Getting Cimzia Covered by Blue Cross Blue Shield in Georgia Cimzia (certolizumab pegol) requires prior authorization from Blue Cross Blue Shield of Georgia (Anthem) for all commercial plans. To get coverage, you need documented failure of step-therapy requirements (typically other TNF inhibitors like Humira), proper diagnosis codes, and

How to Get Krystexxa (Pegloticase) Covered by Blue Cross Blue Shield in Georgia: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Krystexxa Covered by Blue Cross Blue Shield in Georgia Fastest path to approval: Submit prior authorization through BCBS provider portal with complete documentation of failed xanthine oxidase inhibitor trials (allopurinol/febuxostat), G6PD test results, and rheumatology evaluation. Georgia's step therapy exception law (§33-24-59.25) requires

Humana's Coverage Criteria for Haegarda (C1-esterase inhibitor, SC) in Pennsylvania: What Counts as "Medically Necessary"?

Answer Box: Getting Haegarda Covered by Humana in Pennsylvania Humana requires prior authorization for Haegarda (C1-esterase inhibitor, SC) in Pennsylvania. Medical necessity requires confirmed HAE diagnosis with low C4 and abnormal C1-INH levels, documented attack frequency, and often step therapy through oral berotralstat (Orladeyo) or lanadelumab (Takhzyro) first. Fastest path: