Counterforce Health Team

Myths vs. Facts: Getting iLink® Corneal Cross-Linking Covered by Blue Cross Blue Shield in Washington

Answer Box: iLink® Coverage by Blue Cross Blue Shield in Washington Regence Blue Cross Blue Shield and Premera Blue Cross in Washington cover FDA-approved iLink® corneal cross-linking for progressive keratoconus with prior authorization. The fastest path to approval requires documenting disease progression (≥1.0 diopter Kmax increase over 6-12 months)

How Long Does It Take to Get Vyondys 53 (golodirsen) Approved by Blue Cross Blue Shield in New York? Timeline & Appeal Process

Answer Box: Getting Vyondys 53 Approved in New York Getting Vyondys 53 (golodirsen) approved by Blue Cross Blue Shield in New York typically takes 5-14 business days for standard requests, with expedited reviews possible in 24-48 hours for urgent cases. The fastest path requires: (1) genetic testing confirming exon 53

How to Get Strensiq (asfotase alfa) Covered by UnitedHealthcare in Texas: Complete Appeals Guide with Templates

Answer Box: Getting Strensiq Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Strensiq (asfotase alfa) through OptumRx, with no step therapy for existing users. Initial approval requires documented perinatal/infantile-onset or juvenile-onset hypophosphatasia before age 18, persistent low alkaline phosphatase levels, and specialist prescriber. If denied, you have

How to Get Adynovate (Antihemophilic Factor) Covered by Humana in California: Prior Authorization Guide and Appeal Process

Answer Box: Getting Adynovate Covered by Humana in California Adynovate (bdanocog alfa pegol) requires prior authorization from Humana in California. To get approval: 1) Your hematologist submits a medical necessity letter documenting severe hemophilia A (factor VIII <1%), bleeding history, and failed standard treatments via Humana's provider

How to Get Joenja (leniolisib) Covered by Blue Cross Blue Shield in Ohio: Complete PA Guide and Appeal Scripts

Answer Box: Getting Joenja (leniolisib) Covered by Blue Cross Blue Shield in Ohio Joenja (leniolisib) requires prior authorization from Blue Cross Blue Shield plans in Ohio. The fastest path to approval: (1) Confirm genetic testing proves APDS (PIK3CD or PIK3R1 variants), (2) Have your immunologist submit PA via Anthem'

Myths vs. Facts: Getting Nourianz (istradefylline) Covered by UnitedHealthcare in Michigan

Answer Box: Getting Nourianz Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Nourianz (istradefylline), including documentation of Parkinson's disease, concurrent levodopa/carbidopa use, and failure of two different adjunctive therapy classes. Michigan residents have 127 days after final denial to file external review with DIFS. First

How to Get Rezlidhia (olutasidenib) Covered by Blue Cross Blue Shield of Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Rezlidhia Covered by Blue Cross Blue Shield Illinois Blue Cross Blue Shield of Illinois (BCBSIL) requires prior authorization for Rezlidhia (olutasidenib) with documented IDH1 mutation testing and oncology monitoring plan. Submit through their provider portal with FDA-approved mutation results, treatment history, and differentiation syndrome monitoring protocol. BCBSIL

The Requirements Checklist to Get Elevidys (delandistrogene moxeparvovec-rokl) Covered by Aetna (CVS Health) in Ohio

Answer Box: Fast Track to Elevidys Coverage Who qualifies: Ohio patients with confirmed DMD (excluding exon 8/9 deletions), age 4+, ambulatory status, and anti-AAVrh74 antibody titer <1:400. Fastest approval path: Submit complete prior authorization through CVS Specialty with genetic testing, specialist attestation, and Center of Excellence confirmation.

How to Get Pyrukynd (Mitapivat) Covered by Humana in New York: Prior Authorization Guide and Appeal Process

Answer Box: Getting Pyrukynd (Mitapivat) Covered by Humana in New York Pyrukynd (mitapivat) is covered under Humana Medicare Advantage plans as a specialty pharmacy benefit requiring prior authorization. You need genetic confirmation of pyruvate kinase deficiency, prescription from a board-certified hematologist, and clinical severity documentation. If denied, New York residents

How to Get Ferriprox (Deferiprone) Covered by Humana in Virginia: Complete Guide to Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Ferriprox (Deferiprone) Covered by Humana in Virginia Ferriprox requires prior authorization from Humana and must be filled through specialty pharmacy networks. In Virginia, if denied, you have 65 days to appeal internally and 120 days for external review through the State Corporation Commission Bureau of Insurance. Three