Counterforce Health Team

Getting Revcovi (Elapegademase) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Humana Coverage for Revcovi in Washington Humana covers Revcovi (elapegademase) for ADA-SCID under Medicare Advantage and Part D plans, but requires prior authorization with confirmed diagnosis and specialist documentation. In Washington, you have 65 days to appeal denials, with state external review available for medical benefits. First step

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Cigna in Texas: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Besponsa Covered by Cigna in Texas Cigna requires prior authorization for Besponsa (inotuzumab ozogamicin) with CD22-positive B-cell precursor ALL documentation. Submit the Cigna Besponsa CCRD PA form with pathology confirming CD22 status, relapsed/refractory disease history, and medical necessity letter. If denied, file internal appeal within 180

How to Get Luxturna Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Luxturna Covered by Florida Blue Cross Blue Shield Eligibility: Patients with confirmed biallelic RPE65 mutations, age ≥12 months, adequate retinal viability (OCT >100 microns), and treatment at FDA-qualified centers. Fastest path: Have your retinal specialist submit prior authorization via Availity.com or fax to (800) 424-4947

How to Get Tagrisso (osimertinib) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tagrisso Covered by Cigna in Washington Cigna covers Tagrisso (osimertinib) for EGFR-mutated NSCLC with prior authorization. First step today: Have your oncologist submit PA through Cigna's provider portal with EGFR mutation test results, staging, and treatment history. Standard decisions take 72 hours; expedited reviews 24

How Long Does It Take to Get Duopa (Carbidopa/Levodopa Enteral) Approved by UnitedHealthcare in Virginia? Complete Timeline & Appeals Guide

Answer Box: Getting Duopa Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization (PA) for Duopa (carbidopa/levodopa enteral) with 15-day standard review or 72-hour expedited review for urgent cases. Success requires documenting advanced Parkinson's disease, failed oral therapy, and planned PEG-J tube placement. First step: Have your

How to Get Revlimid (lenalidomide) Covered by Blue Cross Blue Shield in Washington: Complete Forms & Appeals Guide

Answer Box: Getting Revlimid (lenalidomide) Covered by Blue Cross Blue Shield in Washington Revlimid (lenalidomide) requires prior authorization from Blue Cross Blue Shield plans in Washington. The fastest path to approval: (1) Verify your plan covers lenalidomide (generic may be preferred over brand Revlimid), (2) Submit PA request through your

How to Get Voydeya (Danicopan) Covered by Humana in Pennsylvania: Complete Appeals Guide

Quick Answer: Getting Voydeya Covered by Humana in Pennsylvania Voydeya (danicopan) requires prior authorization from Humana Medicare Advantage/Part D plans. Your fastest path: Have your hematologist submit a PA request through Humana's provider portal or CoverMyMeds with documentation of PNH diagnosis, failed/inadequate C5 inhibitor therapy, and

How to Get Opfolda (miglustat) Covered by UnitedHealthcare in Ohio: Step Therapy Exceptions and Appeal Scripts

Answer Box: Getting Opfolda Coverage in Ohio Opfolda (miglustat) requires prior authorization from UnitedHealthcare in Ohio and is only approved with Pombiliti for adults with late-onset Pompe disease (LOPD) weighing ≥40 kg who aren't improving on current enzyme replacement therapy. Most denials stem from inadequate documentation of ERT

Myths vs. Facts: Getting Trikafta (elexacaftor/tezacaftor/ivacaftor) Covered by Cigna in Pennsylvania

Answer Box: Getting Trikafta Covered by Cigna in Pennsylvania Eligibility: Cigna requires prior authorization for Trikafta with documented cystic fibrosis, CFTR genotype showing F508del or responsive mutation, and prescription by a CF specialist. Fastest path: Have your CF center submit complete PA packet with genetic testing, medical necessity letter, and

If Pombiliti Isn't Approved by Aetna (CVS Health) in New Jersey: Formulary Alternatives & Exception Paths

Answer Box If Aetna (CVS Health) denies Pombiliti (cipaglucosidase alfa-atga) in New Jersey, formulary alternatives include Lumizyme (alglucosidase alfa) and Nexviazyme (avalglucosidase alfa-ngpt) as preferred ERTs for late-onset Pompe disease. Request a formulary exception by documenting inadequate response to standard ERTs with objective measures (6-minute walk test, pulmonary function). After