Counterforce Health Team

Counterforce Health Team

How Long Does It Take to Get Krystexxa (Pegloticase) Approved by Aetna (CVS Health) in New Jersey? Timeline & Appeal Process

Answer Box: Fastest Path to Approval Getting Krystexxa (pegloticase) approved by Aetna (CVS Health) in New Jersey typically takes 3-15 business days for prior authorization, depending on documentation completeness. Key requirements include rheumatologist prescriber, documented failure of allopurinol and febuxostat (3+ months each), G6PD test results, and methotrexate co-therapy plan.
6 min read

How to Get Koselugo (selumetinib) Covered by Cigna in Pennsylvania: Prior Authorization Guide and Appeals Process

Answer Box: Getting Koselugo (selumetinib) Covered by Cigna in Pennsylvania Koselugo (selumetinib) requires prior authorization from Cigna for pediatric patients with neurofibromatosis type 1 (NF1) and symptomatic, inoperable plexiform neurofibromas. Your prescriber must document NF1 diagnosis, imaging showing inoperable plexiform neurofibromas, baseline heart function (LVEF), and eye exam results. If
6 min read

How to Get Humate-P Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Humate-P Covered by UnitedHealthcare in New Jersey Humate-P (antihemophilic factor/vWF complex) requires prior authorization from UnitedHealthcare through OptumRx. New Jersey's strengthened step therapy protections (effective January 2026) and external review system provide strong patient safeguards. First step today: Have your hematologist document your VWD
6 min read

Requirements Checklist to Get Dupixent (dupilumab) Covered by UnitedHealthcare in Ohio: Forms, Appeals, and Cost-Saving Strategies

Answer Box: Ohio patients need prior authorization through OptumRx for Dupixent coverage by UnitedHealthcare. Submit via provider portal with diagnosis documentation, step therapy failures (topicals for atopic dermatitis, high-dose ICS/LABA for asthma), and medical necessity letter. If denied, appeal within 21 days internally, then external review through Ohio Department
5 min read

How to Get Mavenclad (cladribine tablets) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered in North Carolina UnitedHealthcare requires prior authorization for Mavenclad (cladribine tablets) for relapsing MS, with no explicit step therapy but strict criteria including lymphocyte count ≥800 cells/μL and documented prior DMT failure. If denied, you have 180 days for internal appeals, then 120 days
6 min read