Counterforce Health Team

Counterforce Health Team

Myths vs. Facts: Getting Helixate (Antihemophilic Factor rFVIII) Covered by UnitedHealthcare in Pennsylvania

Quick Answer: Helixate Coverage by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Helixate (antihemophilic factor rFVIII) in Pennsylvania, but coverage is available for confirmed hemophilia A patients. Submit requests via the UHC Provider Portal or call OptumRx at 866-889-8054 with diagnosis documentation (ICD-10 D66), factor VIII levels, and bleeding
5 min read

How Long Does It Take to Get Cabometyx (Cabozantinib) Approved by Aetna CVS Health in Pennsylvania? Complete Timeline Guide

Answer Box: Cabometyx (Cabozantinib) Approval Timeline for Aetna CVS Health in Pennsylvania Cabometyx requires a formulary exception from Aetna CVS Health (excluded from Advanced Control formulary), taking 30-45 days for standard review or 72 hours for expedited cases. Pennsylvania residents benefit from a state external review program with 53% success
6 min read

How to Get Strensiq (asfotase alfa) Covered by Humana in Washington: Prior Authorization Guide with Appeals Process

Answer Box: Getting Strensiq (asfotase alfa) Covered by Humana in Washington Strensiq (asfotase alfa) requires prior authorization from Humana and is likely non-formulary for most Medicare Advantage plans in Washington. Your fastest path: (1) Have your prescriber submit a formulary exception request with medical necessity documentation to Humana Clinical Pharmacy
6 min read

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in Washington: Complete 2025 Guide

Quick Answer: Getting Epidiolex Covered in Washington Epidiolex (cannabidiol) requires prior authorization from Blue Cross Blue Shield plans in Washington, including Premera and Regence. You'll need confirmed diagnosis of Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex seizures, plus documented failure of at least 2 generic anti-seizure medications.
6 min read

Galafold (Migalastat) Approval with UnitedHealthcare in Washington: Answers to the Most Common Questions

Answer Box: Getting Galafold Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Galafold (migalastat) with proof of Fabry disease diagnosis and an amenable GLA variant confirmed by in vitro assay. Initial approval lasts 12 months; reauthorization requires documented positive clinical response. If denied, Washington residents can appeal through
5 min read

How to Get Zolgensma (onasemnogene abeparvovec) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in New Jersey Zolgensma (onasemnogene abeparvovec) requires prior authorization from Humana Medicare Advantage plans. Key requirements include genetic confirmation of SMA with SMN1 mutation, patient under 2 years old, negative AAV9 antibodies, and prescription by a pediatric neurologist at a certified gene therapy
6 min read

UnitedHealthcare's Coverage Criteria for Increlex (Mecasermin) in Georgia: What Counts as "Medically Necessary"?

Answer Box: Getting Increlex Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Increlex (mecasermin) through OptumRx for pediatric patients with severe primary IGF-1 deficiency. Key criteria: height ≤ -3.0 standard deviation scores, IGF-1 levels ≤ -3.0 SDS, normal/elevated growth hormone levels, and pediatric endocrinologist prescription. If denied,
6 min read