Counterforce Health Team

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

How to Get Gamifant (Emapalumab-lzsg) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals, and Medical Necessity Requirements

Quick Answer: To get Gamifant (emapalumab-lzsg) covered by UnitedHealthcare in New York, you need prior authorization showing: (1) confirmed primary HLH meeting HLH-2004 criteria, (2) failure/intolerance of conventional therapy (dexamethasone + etoposide), and (3) FDA-label dosing plan. Submit through the UnitedHealthcare Provider Portal with complete diagnostic documentation. If denied, file

Renewing Jaypirca (Pirtobrutinib) Approval with Aetna CVS Health in California: Complete Timeline & Documentation Guide

Answer Box: Renewing Jaypirca Coverage with Aetna CVS Health Aetna CVS Health requires annual prior authorization (PA) renewal for Jaypirca (pirtobrutinib) in California. Start the renewal process 10-14 days before your current PA expires to avoid treatment gaps. Submit renewal through your oncologist's office via the Aetna provider

How to Get Opdivo (nivolumab) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Opdivo Covered by Blue Cross Blue Shield in Pennsylvania First step: Verify your exact Blue Cross plan (Highmark vs. Independence Blue Cross) and check if Opdivo requires prior authorization for your specific coverage. Fastest approval path: Submit a complete prior authorization request with cancer diagnosis, staging, prior

Renewing Signifor / Signifor LAR (Pasireotide) Approval with Blue Cross Blue Shield in Illinois: 2025 Requirements & Timeline

Answer Box: Renewing Your Signifor Coverage in Illinois Signifor/Signifor LAR renewals with Blue Cross Blue Shield of Illinois require updated clinical documentation showing treatment response, typically every 12 months. Start your renewal 60-90 days before expiration to avoid coverage gaps. You'll need recent urinary free cortisol (UFC)

How to Get Givlaari (givosiran) Covered by Humana in Washington: Complete Appeals Guide with Templates

Answer Box: Quick Path to Givlaari Coverage Humana requires prior authorization for Givlaari (givosiran) in Washington. You'll need: confirmed acute hepatic porphyria (AHP) diagnosis with elevated ALA/PBG labs, ≥2 attacks in past 6 months, specialist prescriber, and documented hemin use/failure. First step today: Call Humana member

Work With Your Doctor to Get Lutathera Approved by Blue Cross Blue Shield in Georgia: Complete Prior Authorization Guide

Quick Answer: Blue Cross Blue Shield of Georgia (Anthem BCBS GA) requires prior authorization for Lutathera for somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors. You'll need SSTR-positive imaging, documented progression on octreotide/lanreotide, and an oncologist's letter of medical necessity. If denied, Georgia allows external review within 60

How to Get Ilaris (canakinumab) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Ilaris (canakinumab) Covered by Cigna in New Jersey Cigna requires prior authorization for Ilaris (canakinumab) across all plan types in New Jersey. The fastest path to approval: (1) Have your rheumatologist complete Cigna's Ilaris-specific PA form with documented CRP ≥10 mg/L, flare history, and