Counterforce Health Team

How to Get Kuvan (Sapropterin) Covered by Humana in Texas: Prior Authorization Guide, Appeals Process & State Protections

Answer Box: Getting Kuvan Covered by Humana in Texas Kuvan (sapropterin) requires prior authorization from Humana with medical necessity documentation proving PKU diagnosis, specialist oversight, and adherence to phenylalanine-restricted diet. Submit via phone (800-555-2546), fax (877-486-2621), or Humana provider portal. Standard decisions take 72 hours; expedited reviews 24 hours if

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tepezza Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) in Ohio, with coverage limited to 8 lifetime infusions for moderate-to-severe thyroid eye disease. You'll need a Clinical Activity Score (CAS) ≥3, euthyroid thyroid labs, and documented steroid failure or contraindication. Submit

Do You Qualify for Venclexta (venetoclax) Coverage by Aetna (CVS Health) in Ohio? Decision Tree & Next Steps

Answer Box: Your Path to Venclexta Coverage in Ohio If you have CLL/SLL or AML and meet FDA criteria, you likely qualify for Venclexta coverage by Aetna (CVS Health) in Ohio. The fastest path: (1) Document BTK inhibitor failure for CLL cases, (2) Complete TLS prevention plan with baseline

How to Get Juxtapid (Lomitapide) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Juxtapid (Lomitapide) Covered by Aetna CVS Health in Pennsylvania Juxtapid (lomitapide) requires prior authorization from Aetna CVS Health for homozygous familial hypercholesterolemia (HoFH) treatment in Pennsylvania. Submit requests through CVS Caremark's ePA portal at Availity.com or fax to 1-866-249-6155. Key requirements: genetic HoFH confirmation,

How to Get Jaypirca (Pirtobrutinib) Covered by Aetna CVS Health in Texas: Prior Authorization, Appeals, and State IRO Process

Answer Box: Getting Jaypirca (Pirtobrutinib) Covered by Aetna CVS Health in Texas Yes, Aetna CVS Health covers Jaypirca (pirtobrutinib) in Texas with prior authorization for FDA-approved indications. The fastest path: Your hematologist/oncologist submits a PA request via Availity portal with documentation of prior BTK inhibitor failure and medical necessity.

How to Get Tagrisso (Osimertinib) Covered by Blue Cross Blue Shield in New York: Appeals Guide and State Protections

Answer Box: Getting Tagrisso Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield requires prior authorization for Tagrisso (osimertinib) in New York. To get approved: (1) Confirm EGFR mutation testing shows qualifying mutations (exon 19 deletion, L858R, T790M), (2) Have your oncologist submit PA request with

How to Get Crysvita (burosumab) Covered by Humana in Pennsylvania: Prior Authorization, Appeals, and Alternative Options

Answer Box: Getting Crysvita (burosumab) Covered by Humana in Pennsylvania Crysvita (burosumab) requires prior authorization from Humana in Pennsylvania. For Medicare Advantage members, submit PA documentation including genetic/FGF23 confirmation of XLH, baseline low serum phosphorus, and specialist attestation via Humana's provider portal. Standard review takes 72 hours;

How to Get Helixate (Antihemophilic Factor, rFVIII) Covered by Blue Cross Blue Shield of North Carolina: Complete PA Guide and Appeal Scripts

Answer Box: Getting Helixate Covered by BCBS North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Helixate (antihemophilic factor, rFVIII) as a specialty medication. Fastest path to approval: 1) Confirm your hematologist will prescribe through BCBSNC's Hemophilia Network pharmacy, 2) Submit PA with hemophilia

Myths vs. Facts: Getting Trikafta Covered by Blue Cross Blue Shield in Washington (2025 PA Guide)

Answer Box: Trikafta requires prior authorization from all Blue Cross Blue Shield plans in Washington, including Premera and Regence. Success depends on proper CFTR genotype documentation (F508del mutation), CF specialist attestation, and complete clinical records—not just a prescription. If denied, you have 180 days to appeal and can request

How to Get Jakafi (Ruxolitinib) Covered by UnitedHealthcare in Washington: Complete Guide to Prior Authorization, Appeals, and IRO Review

Answer Box: Getting Jakafi (Ruxolitinib) Covered by UnitedHealthcare in Washington Jakafi (ruxolitinib) requires prior authorization from UnitedHealthcare, but approval is achievable with proper documentation. For myelofibrosis, provide intermediate/high-risk diagnosis evidence and symptom documentation. For polycythemia vera, document hydroxyurea failure or intolerance. Submit via the UnitedHealthcare provider portal with complete