Counterforce Health Team

Counterforce Health Team

Galafold (Migalastat) Approval with UnitedHealthcare in Washington: Answers to the Most Common Questions

Answer Box: Getting Galafold Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Galafold (migalastat) with proof of Fabry disease diagnosis and an amenable GLA variant confirmed by in vitro assay. Initial approval lasts 12 months; reauthorization requires documented positive clinical response. If denied, Washington residents can appeal through
5 min read

How to Get Zolgensma (onasemnogene abeparvovec) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in New Jersey Zolgensma (onasemnogene abeparvovec) requires prior authorization from Humana Medicare Advantage plans. Key requirements include genetic confirmation of SMA with SMN1 mutation, patient under 2 years old, negative AAV9 antibodies, and prescription by a pediatric neurologist at a certified gene therapy
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UnitedHealthcare's Coverage Criteria for Increlex (Mecasermin) in Georgia: What Counts as "Medically Necessary"?

Answer Box: Getting Increlex Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Increlex (mecasermin) through OptumRx for pediatric patients with severe primary IGF-1 deficiency. Key criteria: height ≤ -3.0 standard deviation scores, IGF-1 levels ≤ -3.0 SDS, normal/elevated growth hormone levels, and pediatric endocrinologist prescription. If denied,
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How to Get Elaprase (Idursulfase) Covered by Humana in Georgia: Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Elaprase (Idursulfase) Covered by Humana in Georgia Humana requires prior authorization for Elaprase (idursulfase), a specialty enzyme replacement therapy for Hunter syndrome (MPS II). To get approval in Georgia: 1. Confirm diagnosis with enzymatic testing (reduced iduronate-2-sulfatase activity) or genetic testing 2. Submit PA request via Humana
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Getting Arikayce (Amikacin Liposome Inhalation) Covered by Blue Cross Blue Shield in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Fast Track to Arikayce Coverage in New Jersey Arikayce (amikacin liposome inhalation) requires prior authorization from Horizon Blue Cross Blue Shield of New Jersey for refractory MAC lung disease. To get approved: (1) Submit PA request with 6+ months of failed standard MAC therapy documentation, (2) Include positive
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How to Get Firdapse (amifampridine) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Firdapse Covered by Blue Cross Blue Shield in Washington Firdapse (amifampridine) requires prior authorization from Blue Cross Blue Shield plans in Washington for Lambert-Eaton myasthenic syndrome (LEMS). To get approval: (1) Ensure confirmed LEMS diagnosis with EMG and anti-VGCC antibodies by a neuromuscular specialist, (2) Submit PA
6 min read