Counterforce Health Team

How to Get Pomalyst (Pomalidomide) Covered by Blue Cross Blue Shield in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Pomalyst Covered by BCBS Georgia Pomalyst (pomalidomide) requires prior authorization from Blue Cross Blue Shield Georgia (Anthem) and must be filled through their specialty pharmacy networks (CarelonRx or BioPlus). To get approved: 1) Your oncologist submits a PA request documenting prior lenalidomide and proteasome inhibitor failure, 2)

Lowering Out-of-Pocket Costs for Procysbi with UnitedHealthcare in Michigan: Copay Cards, Tier Exceptions & Appeals

Answer Box: Getting Procysbi Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Procysbi (cysteamine bitartrate DR) and typically mandates step therapy with immediate-release cysteamine first. Michigan residents have 180 days to appeal denials internally, then 127 days for external review through Michigan DIFS. First step: Have your doctor

Myths vs. Facts: Getting Carbaglu (Carglumic Acid) Covered by Cigna in Florida

Answer Box: The Reality Check Getting Carbaglu (carglumic acid) covered by Cigna in Florida requires prior authorization with specific documentation—not just a prescription. The fastest path: your metabolic specialist submits a PA request with genetic testing results, ammonia levels above normal, and confirmation of protein-restricted diet. If denied, you

How to Get Rylaze Covered by Blue Cross Blue Shield of Illinois: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Rylaze Covered by BCBS Illinois Rylaze requires prior authorization from Blue Cross Blue Shield of Illinois as a specialty oncology drug for ALL/LBL patients with documented hypersensitivity to E. coli-derived asparaginase. Submit PA via the BCBSIL provider portal with detailed reaction records, oncology diagnosis, and treatment

Myths vs. Facts: Getting Ofev (nintedanib) Covered by Humana in Michigan (2025 Appeals Guide)

Answer Box: Getting Ofev (nintedanib) Covered by Humana in Michigan Eligibility: Humana typically requires prior authorization for Ofev, with pulmonologist attestation, HRCT confirming IPF/UIP pattern, and baseline PFTs. Fastest path: Submit complete PA documentation through Humana's provider portal with all required clinical evidence. First step today: Verify

How to Get Firdapse (Amifampridine) Covered by UnitedHealthcare in Texas: Appeals Process, Forms, and Approval Scripts

Answer Box: Getting Firdapse Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Firdapse (amifampridine) in Texas with no step therapy requirement. Submit via the UHC Provider Portal with confirmed LEMS diagnosis (P/Q-type VGCC antibodies + EMG showing ≥60% CMAP increment), neurologist prescription, and no seizure history. Standard approval

How to Get Ilaris (Canakinumab) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Ilaris Covered by Aetna CVS Health in Ohio Aetna CVS Health requires prior authorization for all Ilaris (canakinumab) uses using their Ilaris Injectable Medication Precertification Request form and clinical policy CPB 0881. First step today: Have your rheumatologist or immunologist complete the precert form with your exact

How to Get Poteligeo (mogamulizumab-kpkc) Approved by Aetna CVS Health in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Poteligeo Covered in Washington Poteligeo (mogamulizumab-kpkc) requires prior authorization from Aetna CVS Health for relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy. Your oncologist submits documentation via the Aetna provider portal showing confirmed CTCL diagnosis, prior treatment failures, and medical necessity. If denied,

The Requirements Checklist to Get Revlimid (lenalidomide) Covered by UnitedHealthcare in North Carolina

Answer Box: Getting Revlimid Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Revlimid (lenalidomide) in North Carolina, with specific criteria for multiple myeloma, MDS, and mantle cell lymphoma. The fastest path: verify REMS enrollment, submit PA via UHC provider portal with diagnosis-specific documentation, and use North Carolina&

How to Get Ocrevus (Ocrelizumab) Covered by UnitedHealthcare in California: Renewal Guide, Appeal Scripts, and Timeline

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Ocrevus (ocrelizumab) with annual renewal documentation showing clinical response. Submit via the UHC Provider Portal with MS diagnosis confirmation, prior DMT trials, and evidence of treatment benefit (stable/improved disability scores, reduced relapses, or MRI stability)