Counterforce Health Team

The Requirements Checklist to Get Koselugo (Selumetinib) Covered by Cigna in Michigan: Forms, Appeals, and Clinical Criteria

Answer Box: Quick Path to Koselugo Coverage Cigna requires prior authorization (PA) for Koselugo (selumetinib) in pediatric NF1 patients with symptomatic, inoperable plexiform neurofibromas. Initial approvals last 1 year with reauthorization requiring evidence of benefit. Key requirements: confirmed NF1 diagnosis (ICD-10 Q85.01), baseline LVEF evaluation, ophthalmologic exam, and MRI

Lowering Out-of-Pocket Costs for Spinraza (nusinersen) with Aetna (CVS Health) in Ohio: Copay Programs, Tiering Exceptions, and Financial Assistance

Answer Box: Reducing Spinraza Costs with Aetna (CVS Health) in Ohio Fastest path to lower costs: Enroll in Biogen's Copay Program (commercial insurance only) for $0 copays, then request a formulary/tiering exception if Spinraza is on a high specialty tier. Ohio residents get internal appeals plus external

Do You Qualify for Alecensa (alectinib) Coverage by Aetna (CVS Health) in Georgia? Complete Decision Tree & Appeals Guide

Answer Box: Quick Eligibility Check You likely qualify for Alecensa (alectinib) coverage by Aetna (CVS Health) if you have ALK-positive NSCLC (either metastatic/recurrent disease or adjuvant therapy after complete tumor resection with tumor ≥4cm or node-positive). First step today: Call the number on your Aetna insurance card to confirm

Lowering Out-of-Pocket Costs for Ruconest with UnitedHealthcare in North Carolina: Copay Cards, Appeals & Financial Assistance

Answer Box: Getting Ruconest Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Ruconest (C1 esterase inhibitor [recombinant]) in North Carolina, with 12-month approvals for confirmed hereditary angioedema (HAE) patients prescribed by allergists/immunologists. The fastest path: 1) Have your HAE specialist submit PA via UHC Provider Portal

Myths vs. Facts: Getting Naglazyme (galsulfase) Covered by Humana in Illinois - Complete Guide

Answer Box: Getting Naglazyme (galsulfase) Covered by Humana in Illinois Naglazyme (galsulfase) typically requires prior authorization from Humana in Illinois. Success depends on confirmed MPS VI diagnosis via enzyme assay and genetic testing, plus baseline functional measures like 6-minute walk test. If denied, you have 65 days to appeal and

How to Get Haegarda (C1-esterase inhibitor, SC) Covered by Cigna in New York: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Haegarda Covered by Cigna in New York Cigna requires prior authorization for Haegarda with specialist diagnosis, lab confirmation (low C4), and documented HAE attack history. Submit through your HAE specialist using Cigna's C1-esterase inhibitor PA form. If denied, you have 180 days for internal appeals

Do You Qualify for Luxturna (Voretigene Neparvovec-rzyl) Coverage by Blue Cross Blue Shield in Texas? Decision Tree & Appeals Guide

Answer Box: Getting Luxturna Covered in Texas Yes, Luxturna (voretigene neparvovec-rzyl) can be covered by Blue Cross Blue Shield of Texas for patients with confirmed biallelic RPE65 mutations and sufficient retinal viability. The fastest path: (1) Confirm genetic testing shows biallelic RPE65 pathogenic variants, (2) Submit prior authorization through BCBSTX

How Long Does It Take to Get Cresemba (isavuconazole) Approved by UnitedHealthcare in New Jersey? Timeline & Milestones

Answer Box: Getting Cresemba Approved by UnitedHealthcare in New Jersey Timeline: Standard prior authorization takes up to 15 business days; urgent cases get decisions within 72 hours (24 hours for Medicare plans). First step: Verify your plan's formulary status at the UnitedHealthcare Provider Portal and gather complete clinical

How to Get Tremfya (Guselkumab) Covered by Cigna in Florida: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Tremfya (Guselkumab) Covered by Cigna in Florida Cigna requires prior authorization for Tremfya with step therapy through traditional agents (methotrexate, cyclosporine) or TNF inhibitors for 3+ months. If denied, you have 180 days to file an internal appeal, with 30-day review times for future treatments. External review

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

Quick Answer: Getting Rebif Covered by Cigna in Michigan Rebif (interferon beta-1a) requires prior authorization from Cigna, typically managed through Express Scripts/Accredo specialty pharmacy. Submit initial PA via CoverMyMeds or Cigna provider portal with MS diagnosis, prior DMT failures, and medical necessity documentation. If denied, file internal appeal within