Counterforce Health Team

Aetna's Coverage Criteria for Hemlibra (emicizumab-kxwh) in North Carolina: What Counts as "Medically Necessary"?

Answer Box: Getting Hemlibra Approved by Aetna in North Carolina Aetna covers Hemlibra (emicizumab-kxwh) for hemophilia A prophylaxis when prescribed by a hematologist with documented FVIII deficiency and inhibitor status. Your fastest path: (1) Have your hematologist submit prior authorization via Aetna's provider portal with weight-based dosing, bleeding

How to Get Trikafta Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield of New York (Anthem BCBSNY) requires prior authorization for Trikafta, including genetic testing confirming F508del or other eligible CFTR mutations, CF diagnosis documentation, and specialist attestation. Submit PA through Availity Essentials with complete

How to Get Arikayce Covered by Blue Cross Blue Shield in Ohio: Renewal Guide, Appeals Timeline, and Documentation Checklist

Quick Answer: Arikayce (amikacin liposome inhalation) renewals with Blue Cross Blue Shield Ohio require updated culture results, clinical response documentation, and safety monitoring reports every 6-12 months. Start renewal requests 30-60 days before expiration. Submit via Availity portal for commercial plans or CarelonRx for MyCare Ohio. If denied, you have

Getting Revcovi (Elapegademase) Covered by Humana in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Revcovi (Elapegademase) Covered by Humana in North Carolina To get Revcovi (elapegademase) covered by Humana in North Carolina, you need: confirmed ADA-SCID diagnosis with genetic testing and enzyme levels <1%, specialist evaluation by pediatric immunologist, and documentation of medical necessity. Fastest path: Submit prior authorization through

How to Get Rezlidhia (Olutasidenib) Covered by UnitedHealthcare in Virginia: Complete PA Guide and Appeals Process

Answer Box: Getting Rezlidhia Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Rezlidhia (olutasidenib) with strict documentation of IDH1 mutation and relapsed/refractory AML status. Submit via OptumRx e-PA portal with molecular testing results, treatment history, and monitoring plan. If denied, Virginia's State Corporation Commission provides

How to Get Orladeyo (Berotralstat) Covered by Humana in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Fastest Path to Approval Orladeyo (berotralstat) requires prior authorization from Humana Medicare Advantage plans, typically placed in Tier 5 (Specialty) with coverage through designated specialty pharmacies. Start by having your HAE specialist submit a complete PA packet including confirmed HAE diagnosis (low C4 and C1-INH levels on ≥2

How to Get Uptravi (selexipag) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Started Today To get Uptravi (selexipag) covered by Humana in New Jersey: (1) Confirm WHO Group I PAH diagnosis with right heart catheterization data, (2) Document WHO Functional Class II-IV and failed trials of at least two PAH drug classes, (3) Submit prior authorization via Humana'

Get Crysvita (Burosumab) Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals & Cost Assistance Guide

Answer Box: Fast Track to Coverage Getting Crysvita (burosumab) covered by UnitedHealthcare in New Jersey requires prior authorization with genetic testing or elevated FGF23 levels, specialist involvement, and documentation of failed conventional therapy (especially for adults). Submit through the UnitedHealthcare provider portal with complete medical records. If denied, you have

How to Get Qalsody (Tofersen) Covered by Cigna in Georgia: Complete PA Guide, Appeals Process & Approval Scripts

Answer Box: Fast Track to Qalsody (Tofersen) Approval Eligibility: Cigna covers Qalsody for SOD1-mutation ALS with prior authorization under Coverage Policy IP0567. Fastest path: (1) Confirm your Cigna plan type and whether you need a PCP referral to neurology, (2) Have your ALS neurologist submit complete PA via CoverMyMeds Cigna

Do You Qualify for Givlaari (givosiran) Coverage by UnitedHealthcare in Illinois? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Givlaari Coverage in Illinois Yes, you can get Givlaari (givosiran) covered by UnitedHealthcare in Illinois if you meet specific criteria: age 18+, confirmed acute hepatic porphyria with elevated urinary ALA/PBG levels, and documented attack history (≥2 attacks in past 6 months). UnitedHealthcare requires