Counterforce Health Team

Counterforce Health Team

How to Get Adynovate (bdanocog alfa pegol) Covered by Aetna (CVS Health) in California: Prior Authorization Guide and Appeals Process

Answer Box: Getting Adynovate Covered by Aetna (CVS Health) in California Aetna (CVS Health) requires prior authorization for Adynovate (bdanocog alfa pegol) with specific medical necessity criteria for hemophilia A patients. To get coverage approved: 1. Submit PA request via Aetna Provider Portal or call 1-855-240-0535 for urgent cases (72-hour
6 min read

How to Get Evrysdi (Risdiplam) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Evrysdi Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization (PA) for Evrysdi (risdiplam) in Illinois. To get approved, you need genetic confirmation of 5q SMA, baseline motor function scores (CHOP INTEND or HFMSE), and prescription by an SMA-experienced neurologist. Submit electronically via the UnitedHealthcare Provider Portal.
5 min read

How to Get Filsuvez (Birch Triterpenes Gel) Covered by Blue Cross Blue Shield in Virginia: Complete PA Guide and Appeals Process

Answer Box: Getting Filsuvez Covered by Blue Cross Blue Shield in Virginia Filsuvez (birch triterpenes topical gel) requires prior authorization from Blue Cross Blue Shield in Virginia for epidermolysis bullosa (EB) wound care. Submit PA via your provider with genetic testing confirming dystrophic or junctional EB, wound documentation ≥20 cm²
6 min read

How to Get Pombiliti (cipaglucosidase alfa-atga) Covered by Humana in New Jersey: Appeals Guide with Forms and Timelines

Answer Box: Getting Pombiliti Covered by Humana in New Jersey Pombiliti (cipaglucosidase alfa-atga) requires prior authorization from Humana and is not on their preferred formulary. Your fastest path to approval: (1) Submit a formulary exception request with comprehensive medical necessity documentation showing inadequate response to current ERT, (2) Request expedited
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How to Get Darzalex (Daratumumab) Covered by Aetna CVS Health in New Jersey: Complete PA Forms, Appeals Guide & Contact Directory

Answer Box: Getting Darzalex Covered by Aetna CVS Health in New Jersey Aetna CVS Health requires prior authorization for Darzalex (daratumumab) in New Jersey, submitted via Availity portal or CVS Caremark at 1-800-294-5979. Coverage typically requires documentation of FDA-approved multiple myeloma indications, prior therapy failures, and prescriber attestation. If denied,
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How to Get Filspari (Sparsentan) Covered by Humana in North Carolina: Complete Guide with Forms, Appeals, and Cost-Saving Strategies

Answer Box: Fastest Path to Filspari Coverage Filspari (sparsentan) is covered by Humana Medicare Advantage plans with prior authorization required. Your nephrologist submits a PA request with IgA nephropathy diagnosis, lab results (proteinuria/eGFR), and medical necessity letter via Humana's provider portal or fax (800-555-2546). Standard approval takes
6 min read

How to Get Berinert (C1-Esterase Inhibitor) Covered by UnitedHealthcare in Illinois: Complete PA Guide with Appeals Timeline

Answer Box: Getting Berinert Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Berinert (C1-esterase inhibitor) in Illinois, with approval limited to confirmed HAE diagnoses prescribed by immunologists or allergists. Submit PA via the UHC Provider Portal with HAE lab results (C1-INH levels below normal) and attack history. If
6 min read