Counterforce Health Team

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

Coding That Helps Get Cystadane (Betaine Anhydrous) Approved by UnitedHealthcare in Georgia: ICD-10, Documentation, and PA Requirements

Answer Box: Getting Cystadane Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization (PA) for Cystadane (betaine anhydrous) via OptumRx with specific coding and documentation. Use ICD-10 code E72.11 (homocystinuria) or E72.12 (MTHFR deficiency) with genetic testing confirmation, elevated homocysteine labs, and documented vitamin B6/B12/folate failures.

How to Get Gattex (Teduglutide) Covered by Humana in Washington: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Gattex (Teduglutide) Covered by Humana in Washington Humana requires prior authorization (PA) for Gattex (teduglutide) for short bowel syndrome with parenteral nutrition dependence. Your gastroenterologist submits PA electronically via Humana's provider portal with documented SBS diagnosis, 12+ months of PN logs, recent colonoscopy, and failed

UnitedHealthcare's Coverage Criteria for Acthar Gel in Florida: What Counts as "Medically Necessary"?

Answer Box: Getting Acthar Gel Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Acthar Gel with strict medical necessity criteria. Coverage is primarily limited to infantile spasms in children under 2 years old (4-week approval) and select conditions like opsoclonus-myoclonus syndrome. Most other uses require documented failure of

How to Get Blenrep (Belantamab Mafodotin) Covered by Humana in Texas: PA Requirements, Appeals, and Approval Scripts

Answer Box: Getting Blenrep Covered by Humana in Texas Current Status: Blenrep (belantamab mafodotin) was withdrawn from US markets in 2022 and is only available through clinical trials or expanded access programs. Humana typically denies coverage outside study settings. If pursuing expanded access: (1) Submit prior authorization via Humana'

If Evkeeza Isn't Approved by Aetna CVS Health in Ohio: Formulary Alternatives & Exception Paths

Answer Box: If Aetna CVS Health denies Evkeeza (evinacumab-dgnb) for homozygous familial hypercholesterolemia (HoFH) in Ohio, you have two main paths: try formulary alternatives like Repatha (evolocumab) or Juxtapid (lomitapide), or appeal for a formulary exception. Aetna prefers PCSK9 inhibitors as first-line specialty therapy, requiring documented failure of maximally tolerated