Counterforce Health Team

Counterforce Health Team

Humana's Coverage Criteria for Besponsa (Inotuzumab Ozogamicin) in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Besponsa (Inotuzumab Ozogamicin) Covered by Humana in Illinois Humana Medicare Advantage requires prior authorization for Besponsa through their specialty oncology vendor Evolent Health. Medical necessity requires: CD22-positive B-cell precursor ALL, relapsed/refractory status, prior therapy failures documented, and hepatic monitoring plan. Submit PA via Evolent portal or
6 min read

Aetna (CVS Health)'s Coverage Criteria for Revlimid (Lenalidomide) in Virginia: What Counts as "Medically Necessary"?

Answer Box: Getting Revlimid (Lenalidomide) Covered by Aetna (CVS Health) in Virginia Aetna (CVS Health) covers Revlimid (lenalidomide) with prior authorization when medically necessary for FDA-approved indications like multiple myeloma and certain lymphomas. To qualify: (1) Submit PA with diagnosis confirmation, prior therapy history, and REMS enrollment proof; (2) Include
5 min read

Breyanzi (Lisocabtagene Maraleucel) Approval with UnitedHealthcare in Michigan: Answers to the Most Common Questions

Answer Box: Getting Breyanzi Covered by UnitedHealthcare in Michigan Breyanzi (lisocabtagene maraleucel) requires prior authorization from UnitedHealthcare for all Michigan plans. Your oncologist must submit documentation proving you meet FDA criteria: relapsed/refractory large B-cell lymphoma after ≥2 lines, or CLL/SLL after BTK and BCL-2 inhibitor failure. Treatment must
6 min read

How to Get Chenodal (Chenodiol) Covered by Humana in Florida: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Chenodal Covered by Humana in Florida Humana requires prior authorization for Chenodal (chenodiol) in Florida for FDA-approved uses like radiolucent gallstones or cerebrotendinous xanthomatosis (CTX). Submit the Request for Medicare Prescription Drug Coverage Determination form with imaging confirming radiolucent stones, documented ursodiol failure (≥6 months), and surgical
6 min read