Counterforce Health Team

How to Get Dupixent (dupilumab) Covered by Cigna in California: Complete Prior Authorization Guide with Forms and Appeal Scripts

Quick Answer: Getting Dupixent Covered by Cigna in California Cigna requires prior authorization for Dupixent (dupilumab) with specific medical necessity criteria. For atopic dermatitis, you'll need documented failure of topical corticosteroids and calcineurin inhibitors. For eosinophilic asthma, blood eosinophil count ≥150 cells/μL and failed high-dose ICS/LABA

How to Get Spinraza (Nusinersen) Covered by Cigna in Ohio: Prior Authorization Guide, Appeals Process, and State Protections

Answer Box: Getting Spinraza Covered by Cigna in Ohio Cigna requires prior authorization for Spinraza (nusinersen) with genetic testing documentation and specialist consultation. Ohio provides strong consumer protections including 180-day internal appeal windows and independent external review through the Ohio Department of Insurance. Fastest path to approval: 1. Ensure genetic

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by UnitedHealthcare in New York: Complete PA Guide and Appeals Strategy

Answer Box: Getting Mepsevii Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization (PA) for Mepsevii (vestronidase alfa-vjbk) across all plan types with no step therapy typically required for commercial plans. To get approved: (1) Confirm MPS VII diagnosis via β-glucuronidase enzyme assay or GUSB genetic testing, (2) Submit

How to Get Elevidys Covered by Humana in Virginia: Complete Prior Authorization Guide with Forms and Appeal Scripts

Answer Box: Getting Elevidys Covered by Humana in Virginia Elevidys (delandistrogene moxeparvovec-rokl) requires prior authorization from Humana for ambulatory DMD patients aged 4+ with confirmed genetic mutations. First step: Verify your plan type (Medicare Advantage vs. Part D) and contact a certified DMD center in Virginia. Fastest path: Submit PA

Get Rylaze Covered by Humana in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Rylaze Covered by Humana in Virginia Yes, Humana covers Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) with prior authorization for patients ≥1 month with ALL/LBL who've had Grade 2+ hypersensitivity reactions to E. coli asparaginase. Your oncologist submits the PA through Humana's provider

How to Get Bylvay (Odevixibat) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Bylvay Covered by Cigna in Pennsylvania Bylvay (odevixibat) requires prior authorization from Cigna for PFIC or Alagille syndrome patients. Your hepatologist must submit documentation proving diagnosis, moderate-to-severe pruritus, and failure of at least two systemic medications. If denied, Pennsylvania's Independent External Review Program offers a

Myths vs. Facts: Getting Pyrukynd (Mitapivat) Covered by Cigna in Washington

Quick Answer: Getting Pyrukynd Covered by Cigna in Washington Yes, Cigna covers Pyrukynd (mitapivat) with prior authorization. You need confirmed PKLR gene mutations (≥2 variants, ≥1 missense), hemoglobin ≤10 g/dL OR ≥6 transfusions in 12 months, and a hematologist prescription. If denied, Washington's strong external review process

Vigabatrin (Sabril) Coverage with UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vigabatrin Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization (PA) for vigabatrin (Sabril) with mandatory REMS enrollment for prescriber, patient, and pharmacy, plus baseline vision testing documentation. The fastest path to approval: (1) Complete REMS enrollment at vigabatrinrems.com for all parties, (2) Gather baseline vision

Do You Qualify for Acthar Gel Coverage by Aetna CVS Health in Texas? Decision Tree & Next Steps

Answer Box: Acthar Gel Coverage by Aetna CVS Health in Texas Yes, you can get Acthar Gel covered by Aetna CVS Health in Texas, but prior authorization is required for all uses. Your best path to approval: 1. Confirm eligibility: Infantile spasms (under 24 months) or MS exacerbations after steroid

How to Get Rebif (Interferon Beta-1a) Covered by Cigna in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Rebif Covered by Cigna in Pennsylvania Rebif (interferon beta-1a) requires prior authorization from Cigna, but Pennsylvania's strengthened insurance laws work in your favor. First, verify your plan uses Express Scripts/Accredo specialty pharmacy. Your neurologist must submit clinical documentation showing relapsing MS diagnosis, MRI evidence