Counterforce Health Team

Takhzyro (lanadelumab-flyo) Approval with Humana in New York: Answers to the Most Common Questions

Answer Box: Getting Takhzyro Covered by Humana in New York Takhzyro (lanadelumab-flyo) requires prior authorization from Humana for hereditary angioedema (HAE) prophylaxis. You'll need confirmed HAE type I/II diagnosis with lab documentation, specialist prescriber, and evidence of prior therapy failures. If denied, New York residents can file

How to Get Sumavel DosePro (Sumatriptan Injection, Needle-Free) Covered by Humana in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Sumavel DosePro Covered by Humana in Pennsylvania Sumavel DosePro (needle-free sumatriptan injection) was discontinued in the U.S., but generic sumatriptan auto-injectors remain available. For Humana Medicare Advantage/Part D coverage in Pennsylvania: 1) Check if your plan requires prior authorization or step therapy through oral triptans

How to Get Cresemba (Isavuconazole) Covered by Cigna in Georgia: Complete PA Guide with Forms and Appeals Timeline

Answer Box: Cresemba (isavuconazole) requires prior authorization from Cigna for invasive aspergillosis and mucormycosis. Submit PA via CoverMyMeds or Surescripts portal with confirmed diagnosis, culture results, and ID specialist documentation. If denied, you have 180 days for internal appeal, then 60 days for Georgia DOI external review. Start with your

Myths vs. Facts: Getting Elelyso (Taliglucerase Alfa) Covered by UnitedHealthcare in Ohio

Answer Box: The Truth About UnitedHealthcare Elelyso Coverage in Ohio UnitedHealthcare requires prior authorization for Elelyso (taliglucerase alfa) with VPRIV as the preferred ERT. Approval requires confirmed Type 1 Gaucher disease diagnosis, specialist prescriber, and documented medical necessity—often after trying VPRIV first. If denied, Ohio residents have 180 days

How to Get Kanuma (Sebelipase Alfa) Covered by Blue Cross Blue Shield in Ohio: Complete Appeals Guide and Financial Assistance

Answer Box: Getting Kanuma Covered by Blue Cross Blue Shield in Ohio Blue Cross Blue Shield (Anthem) in Ohio requires prior authorization for Kanuma (sebelipase alfa) under medical benefits, governed by Clinical Criteria document CC-0037. To get approved: (1) Confirm LAL-D diagnosis with both reduced LAL enzyme activity and biallelic

How to Get Jakafi (ruxolitinib) Covered by Cigna in New York: Prior Authorization Guide and Appeals Process

Answer Box: Quick Path to Jakafi Coverage Getting Jakafi (ruxolitinib) covered by Cigna in New York requires prior authorization with specific documentation. For myelofibrosis, you'll need diagnosis confirmation and symptom documentation. For polycythemia vera, you must show hydroxyurea failure or intolerance. Submit through Cigna's provider portal

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Blue Cross Blue Shield in Virginia: PA Forms, Appeal Scripts & State Protections

Answer Box: Getting Orkambi Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield (Anthem) in Virginia requires prior authorization for Orkambi (lumacaftor/ivacaftor) with genetic testing proving F508del mutations and age ≥2 years. Virginia's step therapy laws protect CF patients with documented contraindications or prior

Do You Qualify for Gattex (Teduglutide) Coverage by Cigna in Texas? Decision Tree & Next Steps

Answer Box: Getting Gattex (Teduglutide) Covered by Cigna in Texas Quick Path to Approval: Cigna requires prior authorization for Gattex with strict criteria: confirmed short bowel syndrome, ≥12 months parenteral nutrition dependence (≥3 days/week with documented logs), gastroenterologist prescription, recent colonoscopy, and weight-based dosing. Submit via Cigna PA form

How to Get Vyondys 53 (golodirsen) Covered by Cigna in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Vyondys 53 Covered by Cigna in New Jersey Vyondys 53 (golodirsen) requires prior authorization from Cigna with genetic testing confirming an exon 53-amenable DMD mutation, age under 16, and ambulatory function (6-minute walk test ≥250 meters). Your neurologist submits the PA through Express Scripts with complete genetic

How to Renew Epidiolex (Cannabidiol) Approval with Aetna CVS Health in Illinois: 2025 Requirements and Timeline

Answer Box: Renewing Your Epidiolex Approval To renew Epidiolex (cannabidiol) with Aetna CVS Health in Illinois, submit your prior authorization renewal 30-60 days before expiration with updated clinical documentation showing ongoing seizure control and liver function monitoring. Most renewals require: confirmed epilepsy diagnosis (LGS, Dravet, or TSC), current weight-based dosing