Counterforce Health Team

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Get Orkambi Covered by Cigna in Pennsylvania Cigna requires prior authorization (PA) for Orkambi (lumacaftor/ivacaftor) coverage in Pennsylvania. Your fastest path to approval: (1) Download Cigna's Orkambi PA form, (2) Have your CF specialist complete it with genetic testing confirming F508del homozygous mutation, and (3)

How to Get Givlaari (givosiran) Covered by UnitedHealthcare in Georgia: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Givlaari Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Givlaari (givosiran) in Georgia using HCPCS code J0223, ICD-10 E80.21 for acute intermittent porphyria, with documented ≥2 attacks in 6 months, hemin failure, and specialist prescriber. Submit via UnitedHealthcare Provider Portal with medical necessity letter,

Getting Entresto Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval UnitedHealthcare requires prior authorization for Entresto (sacubitril/valsartan) in North Carolina. To get approved: Your cardiologist must document heart failure with LVEF ≤40%, NYHA Class II-IV symptoms, and prior ACE inhibitor/ARB trial or intolerance. Submit through UnitedHealthcare Provider Portal with recent echocardiogram, clinical

How to Get Hemlibra (Emicizumab) Covered by UnitedHealthcare in Virginia: Complete PA Guide, Appeals, and Templates

Answer Box: Quick Path to Hemlibra Coverage in Virginia UnitedHealthcare requires prior authorization for all Hemlibra (emicizumab-kxwh) prescriptions. For hemophilia A patients with factor VIII inhibitors ≥5 Bethesda units, there's no step therapy requirement. Submit PA through the UnitedHealthcare Provider Portal with complete clinical documentation including inhibitor titers,

How to Get Prolastin-C Approved by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Prolastin-C Approved by UnitedHealthcare in Pennsylvania Prolastin-C requires prior authorization from UnitedHealthcare OptumRx for Pennsylvania patients. To get approved: (1) Gather genetic testing showing Pi*ZZ genotype, recent lung function tests (FEV1), and chest CT showing emphysema, (2) Submit PA via UHCprovider.com portal with ICD-10 codes

How to Get Givlaari (givosiran) Covered by Humana in New York: Complete Appeals Guide with Forms and Scripts

Answer Box: Fast Track to Givlaari (givosiran) Coverage Givlaari (givosiran) requires prior authorization for all Humana Medicare Advantage plans in New York. Submit via Humana's provider portal with attack history (≥2 in 6 months), elevated ALA/PBG labs, and specialist prescriber documentation. Standard decisions take 72 hours; expedited

How to Get Defitelio (defibrotide) Covered by Cigna in North Carolina: Complete PA Guide and Appeals Process

Answer Box: Getting Defitelio Covered by Cigna in North Carolina Defitelio (defibrotide) requires prior authorization from Cigna for hepatic veno-occlusive disease (VOD/SOS) with organ dysfunction post-stem cell transplant. Submit PA through electronic portals like CoverMyMeds or Evicore for fastest approval (often same-day). Include HSCT details, VOD/SOS diagnosis with

How to Get Mycapssa (Octreotide Oral) Covered by Humana in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mycapssa Covered by Humana in Texas Humana requires prior authorization for Mycapssa (oral octreotide capsules) for acromegaly maintenance treatment. Your fastest path to approval: 1) Confirm you've responded to injectable octreotide or lanreotide, 2) Have your endocrinologist submit a PA request via Humana's

How to Get Natpara (Parathyroid Hormone) Covered by Cigna in Texas: Appeals Guide for Discontinued Drug

Answer Box: Getting Natpara (Parathyroid Hormone) Covered by Cigna in Texas Important: Natpara was discontinued by Takeda in December 2024, with the U.S. Special Use Program ending December 31, 2025. New prescriptions are no longer available. However, if you received a Cigna denial for Natpara before discontinuation or need

How to Get Hemlibra (Emicizumab) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization Guide

Answer Box: Getting Hemlibra Covered by BCBS New York To get Hemlibra (emicizumab-kxwh) covered by Blue Cross Blue Shield in New York: Submit prior authorization through your hemophilia treatment center with diagnosis documentation (ICD-10: D66), Factor VIII levels <5%, inhibitor titer results, and evidence of inadequate prophylaxis with standard