Counterforce Health Team

How Long Does It Take to Get Berinert (C1-esterase inhibitor, IV) Approved by UnitedHealthcare in Georgia? Complete Timeline & Appeals Guide

Answer Box: Quick Path to Berinert Approval in Georgia UnitedHealthcare requires prior authorization for Berinert (C1-esterase inhibitor, IV) in Georgia, with decisions typically taking 72 hours for urgent HAE cases or 30 days for standard requests. To get coverage: 1. Submit PA online via UnitedHealthcare Provider Portal with HAE diagnosis

How to Get Zokinvy (lonafarnib) Covered by Aetna in Texas: Complete PA Guide with Appeals Process

Answer Box: Getting Zokinvy Covered by Aetna in Texas Zokinvy (lonafarnib) requires prior authorization from Aetna with specialty pharmacy dispensing through CVS Specialty. Submit PA with genetic confirmation (LMNA variant for HGPS), baseline ECG showing QTc ≤500ms, and specialist documentation. If denied, Texas law provides internal appeals (180 days) and

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xywav Covered by Cigna in Michigan Cigna requires prior authorization for Xywav (Ca/Mg/K/Na oxybates) with mandatory REMS enrollment. The fastest path: (1) Complete REMS certification for both prescriber and patient, (2) Submit PA via CoverMyMeds with sleep study reports and step therapy documentation, (3)

How to Get Lamzede (velmanase alfa-tycv) Covered by UnitedHealthcare in Virginia: Complete PA Guide and Appeals Process

Quick Answer: Getting Lamzede Covered by UnitedHealthcare in Virginia Lamzede (velmanase alfa-tycv) requires prior authorization through OptumRx for UnitedHealthcare pharmacy benefits. Submit your request via CoverMyMeds electronic PA with confirmed alpha-mannosidosis diagnosis (enzyme activity <10% normal, ICD-10 E77.1), genetic testing showing biallelic MAN2B1 variants, and documentation of non-CNS

How to Get Krystexxa (Pegloticase) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Answer Box: Get Krystexxa Covered by Aetna CVS Health in California Krystexxa (pegloticase) requires prior authorization from Aetna CVS Health for chronic gout patients who've failed allopurinol AND febuxostat. Submit complete documentation including G6PD test results, prior therapy records, and rheumatologist notes via medical benefit (J2507). If denied,

Renewing Opzelura (Ruxolitinib Cream) Coverage with Humana in New Jersey: Timeline, Documentation & Appeal Guide

Answer Box: Renewing Opzelura Coverage with Humana in New Jersey Humana typically requires annual reauthorization for Opzelura (ruxolitinib cream). Start renewal 60-90 days before expiration. Submit updated dermatology notes documenting treatment response (IGA 0/1 for atopic dermatitis or F-VASI-75 for vitiligo), adherence, and continued medical necessity. If denied, file

How to Get Imbruvica (ibrutinib) Covered by Aetna (CVS Health) in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Imbruvica Covered by Aetna in Pennsylvania Aetna (CVS Health) requires prior authorization for Imbruvica (ibrutinib) but does not mandate step therapy for CLL/SLL. Standard approval takes 15 business days; expedited requests are processed within 72 hours. If denied, you have 180 days to appeal internally, followed

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Cigna in Washington: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Upstaza Covered by Cigna in Washington Cigna requires prior authorization for Upstaza (eladocagene exuparvovec) under Coverage Policy IP0725 for patients ≥18 months with confirmed AADC deficiency, managed through Express Scripts/Accredo specialty pharmacy. Submit PA via CoverMyMeds portal or call Accredo at 800-753-2851. If denied, Washington residents

How to Get Oxervate (cenegermin) Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Oxervate Covered by Aetna CVS Health in Texas Oxervate (cenegermin) is covered by Aetna CVS Health as a non-preferred specialty drug requiring prior authorization and step therapy. For Stage 2-3 neurotrophic keratitis patients ≥2 years old, you'll need documented failure of preservative-free artificial tears and

How to Get Kuvan (Sapropterin) Covered by Cigna in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Kuvan Covered by Cigna in Pennsylvania Cigna requires prior authorization for Kuvan (sapropterin dihydrochloride) with specific clinical criteria. For initial therapy, you need a metabolic specialist's prescription plus a phenylalanine-restricted diet. For continuing therapy, document ≥20% phenylalanine reduction from baseline. First step today: Have your