Counterforce Health Team

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

How to Get Orkambi (lumacaftor/ivacaftor) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Orkambi Covered in Washington UnitedHealthcare requires prior authorization for Orkambi (lumacaftor/ivacaftor) based on confirmed cystic fibrosis diagnosis, homozygous F508del CFTR mutation documentation, and prescription by a CF specialist. Submit through OptumRx with genetic lab results, ICD-10 E84.0-E84.9, and clinical notes. If denied, Washington residents

How to Get Lamzede (velmanase alfa-tycv) Covered by Blue Cross Blue Shield in Georgia: Complete PA Guide and Appeal Process

Answer Box: Getting Lamzede Covered by BCBS Georgia Blue Cross Blue Shield of Georgia requires prior authorization for Lamzede (velmanase alfa-tycv) through their specialty medication precertification process. Submit requests via Availity Essentials or Anthem's provider portal with complete documentation including alpha-mannosidosis diagnosis (enzyme deficiency + MAN2B1 genetic variants), clinical

How to Get Crysvita (burosumab) Covered by UnitedHealthcare in Ohio: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Crysvita Covered in Ohio UnitedHealthcare requires prior authorization for Crysvita (burosumab) through OptumRx for X-linked hypophosphatemia (XLH) and tumor-induced osteomalacia. Submit via the UnitedHealthcare Provider Portal with genetic testing, low serum phosphorus labs, and specialist prescription. If denied, you have 180 days for internal appeals, then external

If Rapivab (Peramivir) Isn't Approved by Humana in Texas: Formulary Alternatives & Exception Paths

Answer Box: Quick Path to Coverage If Humana denies Rapivab (peramivir) in Texas: First, try formulary alternatives like oseltamivir (generic Tamiflu) or baloxavir (Xofluza). If alternatives fail or are contraindicated, request an exception with a medical necessity letter documenting why IV therapy is required. Next step: Call Humana at 800-867-6601

The Complete Requirements Checklist to Get Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in New York

Answer Box: Getting Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in New York Prior authorization is required for Imbruvica (ibrutinib) by all BCBS plans in New York. Submit through your plan's provider portal with diagnosis confirmation, prior therapy documentation, and NCCN guideline support. If denied, New York&

How to Get Filspari (sparsentan) Covered by Humana in Ohio: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Filspari Covered by Humana in Ohio Filspari (sparsentan) requires prior authorization from Humana with mandatory REMS enrollment and IgA nephropathy documentation. Submit PA through Humana's provider portal with kidney biopsy, UPCR ≥0.5-0.8 g/g, ACE/ARB failure records, and baseline liver tests. If