Counterforce Health Team

How to Get Tysabri (natalizumab) Covered by Blue Cross Blue Shield in Ohio: Complete Appeals Guide with Forms and Templates

Answer Box: Fastest Path to Tysabri Coverage in Ohio To get Tysabri (natalizumab) covered by Blue Cross Blue Shield in Ohio: First, enroll in the mandatory TOUCH REMS program at touchprogram.com or call 1-800-456-2255. Your neurologist must then submit a prior authorization through Anthem's provider portal with

How to Get Xenpozyme (Olipudase Alfa) Covered by Cigna in Michigan: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Xenpozyme Covered by Cigna in Michigan Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Cigna for all ASMD cases, with fulfillment through Express Scripts/Accredo specialty pharmacy. First step today: Have your specialist submit the PA form with genetic testing results (biallelic SMPD1 variants) and enzyme activity <

How to Get Joenja (leniolisib) Covered by Aetna (CVS Health) in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval To get Joenja (leniolisib) covered by Aetna (CVS Health) in Georgia: Submit prior authorization through Aetna's provider portal with genetic confirmation of APDS (PIK3CD/PIK3R1 variant), specialist prescription, and documented clinical necessity. If denied, file internal appeal within 180 days, then Georgia

How to Get Humira (adalimumab) Covered by Aetna (CVS Health) in Pennsylvania: 2024 Forms, Appeals & Contact Guide

Answer Box: Getting Humira Covered by Aetna in Pennsylvania Pennsylvania Aetna members need prior authorization for Humira (adalimumab), but benefit from the state's step therapy exemption for fully insured plans. Submit the Aetna precertification form with TB screening and prior therapy documentation. If denied, appeal within 60 days

How to Get Kineret (anakinra) Covered by Humana in Florida: Complete Prior Authorization Guide

Answer Box: Getting Kineret (anakinra) Covered by Humana in Florida Kineret (anakinra) requires prior authorization from Humana for rheumatoid arthritis and NOMID coverage in Florida. Your fastest path: 1) Have your rheumatologist submit a PA request through Humana's provider portal with documented DMARD failures and current disease activity,

How to Get Xyrem (Sodium Oxybate) Covered by Blue Cross Blue Shield in Florida: Complete Guide to Forms, Appeals, and Prior Authorization

Answer Box: Getting Xyrem Covered by Blue Cross Blue Shield in Florida Florida Blue requires prior authorization for Xyrem (sodium oxybate) with strict medical necessity criteria for narcolepsy patients age 7 and older. The fastest path to approval: (1) Enroll in XYREM REMS program first, (2) Submit PA via CoverMyMeds

Coding That Helps Get Zokinvy (Lonafarnib) Approved in Illinois with Aetna (CVS Health): ICD-10, HCPCS/J-Code, NDC

Answer Box Zokinvy (lonafarnib) requires prior authorization from Aetna (CVS Health) using ICD-10 code E34.8 (progeria), HCPCS J8499, and specific NDCs (60923-0544-53, 73079-0050-30). Submit genetic confirmation, BSA calculations, and specialist oversight through CVS Specialty Pharmacy. Illinois residents have 4 months to file external appeals through the Illinois Department of

How to Get Elfabrio (pegunigalsidase alfa-iwxj) Covered by Aetna (CVS Health) in California: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Elfabrio Covered by Aetna (CVS Health) in California Aetna (CVS Health) requires prior authorization for Elfabrio (pegunigalsidase alfa-iwxj) with confirmed Fabry disease diagnosis, specialist prescriber, and weight-based dosing documentation. Submit through CVS Specialty enrollment forms or Aetna provider portal. If denied, file internal appeal within 180 days,

How to Get Photrexa (Riboflavin) Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Photrexa Covered by Aetna CVS Health in New York Yes, Aetna CVS Health covers Photrexa (riboflavin ophthalmic solution) for progressive keratoconus with prior authorization. To get approved in New York: (1) Your cornea specialist submits prior authorization with serial topography showing progression, (2) Aetna typically decides within

How to Get Cimzia (Certolizumab Pegol) Covered by Cigna in Texas: Complete PA Guide & Appeal Process

Answer Box: Getting Cimzia Covered by Cigna in Texas Cigna requires prior authorization for Cimzia (certolizumab pegol) with 6-month initial approvals and 1-year renewals. Most patients need to try preferred TNF inhibitors first (adalimumab biosimilars, Enbrel) unless medically contraindicated. Your fastest path: Have your rheumatologist/gastroenterologist submit the Cigna PA