Counterforce Health Team

How to Get Opzelura (ruxolitinib cream) Covered by Blue Cross Blue Shield in Ohio: Complete Appeal Guide with Templates

Answer Box: Getting Opzelura Covered by Blue Cross Blue Shield in Ohio Blue Cross Blue Shield (BCBS) plans in Ohio typically cover Opzelura (ruxolitinib cream) with prior authorization after documented failure of topical steroids and calcineurin inhibitors. Here's your fastest path: 1. Check your specific BCBS Ohio formulary

How to Get Oxlumo (Lumasiran) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Oxlumo (Lumasiran) Approved by Aetna CVS Health in Virginia Aetna CVS Health requires prior authorization for Oxlumo (lumasiran) in Virginia with genetic confirmation of PH1, baseline urinary oxalate levels, and specialist prescriber. Submit the Aetna Oxlumo Precertification Request Form with AGXT testing and labs. Standard approval takes

How to Get Onpattro (patisiran) Covered by UnitedHealthcare in Michigan: Complete Renewal Guide with Appeals Process

Answer Box: Getting Onpattro Covered by UnitedHealthcare in Michigan Onpattro (patisiran) requires prior authorization from UnitedHealthcare in Michigan for hereditary transthyretin-mediated amyloidosis polyneuropathy (hATTR-PN). Submit requests through the UHC Provider Portal with genetic testing, neurologist evaluation, and functional scores (mNIS+7, 6MWT, PND ≤IIIb). UnitedHealthcare must respond within 15 days

Qinlock (Ripretinib) Approval with Humana in Virginia: Answers to the Most Common Questions

Answer Box: Getting Qinlock Covered by Humana in Virginia Qinlock (ripretinib) requires prior authorization from Humana with documented failure of three prior kinase inhibitors: imatinib, sunitinib, and regorafenib. Submit PA via Humana's provider portal with complete treatment history, pathology confirming advanced GIST, and imaging showing disease progression. Standard

How to Get Kesimpta (ofatumumab) Covered by UnitedHealthcare in Virginia: Appeals Guide with Forms and Timelines

Answer Box: Getting Kesimpta Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Kesimpta (ofatumumab) with step therapy requirements in Virginia. Most denials stem from missing documentation or inadequate prior DMT failure records. Your fastest path: 1) Gather complete medical records showing relapsing MS diagnosis and prior treatment failures,

How to Renew Ofev (nintedanib) with Aetna CVS Health in Texas: Documentation Requirements and Timeline

Answer Box: Renewing Ofev (nintedanib) with Aetna CVS Health in Texas Aetna CVS Health requires renewal documentation every 12 months for Ofev (nintedanib). Start preparation 60 days before expiration with updated pulmonary function tests, HRCT results, and clinical notes showing disease stabilization or slowed progression. Submit via Aetna's

UnitedHealthcare's Coverage Criteria for Cabometyx (cabozantinib) in Ohio: What Counts as "Medically Necessary"?

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Cabometyx (cabozantinib) with specific medical necessity criteria by cancer type. Fastest path: Have your oncologist submit PA through the UHC Provider Portal with complete diagnosis, staging, prior therapy documentation, and imaging results. For RCC: Stage IV

How to Get Gamifant (Emapalumab-lzsg) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Gamifant Covered in New York Blue Cross Blue Shield plans in New York cover Gamifant (emapalumab-lzsg) for primary HLH with prior authorization. The fastest path: (1) Submit PA with complete HLH-2004 diagnostic criteria documentation and proof of conventional therapy failure, (2) Use Empire/Excellus provider portal with

How to Get Emgality (galcanezumab-gnlm) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Emgality (galcanezumab-gnlm) requires prior authorization from Humana in New Jersey, but you have strong protections under state law. First step: Have your doctor submit a PA request documenting failed preventive treatments and citing New Jersey's step therapy exception requirements (P.L. 2025, c.50). If denied,

UnitedHealthcare's Coverage Criteria for Firdapse (amifampridine) in New Jersey: What Counts as "Medically Necessary"?

Answer Box: Getting Firdapse Approved by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Firdapse (amifampridine) through OptumRx with confirmed LEMS diagnosis by a neurologist, diagnostic testing (EMG and VGCC antibodies), and no seizure history. No step therapy is required. If denied, you have 60 days to appeal internally,