Counterforce Health Team

Counterforce Health Team

How to Get Spinraza (nusinersen) Covered by UnitedHealthcare in Michigan: Complete PA Guide and Appeals Process

Quick Answer: Getting Spinraza Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization (PA) for Spinraza (nusinersen) with strict genetic and clinical documentation. Submit genetic confirmation of 5q SMA, baseline motor function scores (HFMSE/RULM), and neurologist prescription through the UHC provider portal. If denied, you have 180 days for
6 min read

How to Get Rapivab (Peramivir) Covered by Blue Cross Blue Shield in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rapivab Covered in Georgia Rapivab (peramivir) requires prior authorization from Blue Cross Blue Shield Georgia for acute influenza treatment within 48 hours of symptom onset. Success depends on documenting positive flu test results, contraindications to oral antivirals (oseltamivir/zanamivir), and high-risk patient status. If denied, Georgia residents
5 min read

Renewing Bavencio (Avelumab) Approval with Blue Cross Blue Shield Michigan: Complete Documentation Guide

Answer Box: Renewing Bavencio Coverage in Michigan Bavencio (avelumab) requires prior authorization renewal from Blue Cross Blue Shield of Michigan through their Oncology Value Management program managed by OncoHealth. Submit renewal requests 30-45 days before your current authorization expires using updated medical necessity documentation, recent imaging results, and treatment response
6 min read

How to Get Imbruvica (Ibrutinib) Covered by Humana in California: Prior Authorization Forms, Appeals Timeline, and State Protections

Answer Box: Getting Imbruvica Covered by Humana in California Humana Medicare Advantage plans in California typically require prior authorization for Imbruvica (ibrutinib), with 72-hour response times for urgent cases. If denied, California's Independent Medical Review (IMR) overturns 55-68% of specialty drug denials. Start today: Call Humana Clinical Pharmacy
6 min read

How to Get Brineura (Cerliponase Alfa) Covered by Cigna in North Carolina: Appeals, Prior Authorization, and Coverage Guide

Answer Box: Getting Brineura Covered by Cigna in North Carolina Brineura (cerliponase alfa) requires prior authorization from Cigna for CLN2 disease patients ≥3 years old. First step: Have your pediatric neurologist submit a PA request through Express Scripts/Accredo with CLN2 diagnosis confirmation, TPP1 enzyme testing, and medical necessity documentation.
5 min read

How Long Does It Take to Get Uplizna (Inebilizumab) Approved by Humana in Pennsylvania? Complete Timeline Guide

Answer Box: Uplizna (Inebilizumab) Approval Timeline with Humana in Pennsylvania Humana Medicare Advantage plans require prior authorization for Uplizna (inebilizumab), typically deciding within 7 days for standard requests or 72 hours for expedited cases. Pennsylvania patients benefit from a state external review process that overturns ~50% of denials. Key requirements:
6 min read