Counterforce Health Team

Getting Onivyde (Irinotecan Liposome) Covered by UnitedHealthcare in Georgia: Complete Prior Authorization and Appeals Guide

Quick Answer: Do You Qualify for Onivyde Coverage? Yes, if you have metastatic pancreatic adenocarcinoma and meet UnitedHealthcare's clinical criteria. The fastest path: your oncologist submits a prior authorization through the UnitedHealthcare Provider Portal with documentation of diagnosis, ECOG performance status 0-1, and prior therapy history. If denied,

How to Get Cystadane (betaine anhydrous) Covered by Humana in New York: Prior Authorization, Appeals, and Bridge Options

Answer Box: Getting Cystadane Covered by Humana in New York Humana Medicare Advantage plans typically require prior authorization for Cystadane (betaine anhydrous) for homocystinuria. In New York, you have strong appeal rights through both federal Medicare processes and the state's Department of Financial Services external review. First step

How to Get Bavencio (avelumab) Covered by Humana in North Carolina: Prior Authorization Guide and Appeals Process

Answer Box: Getting Bavencio (avelumab) Covered by Humana in North Carolina Bavencio (avelumab) requires prior authorization from Humana but is covered for FDA-approved indications (metastatic Merkel cell carcinoma and certain urothelial carcinoma cases). Fastest path to approval: Submit complete PA with diagnosis, staging, performance status, and treatment history. First step

How to Get Stelara (Ustekinumab) Covered by Humana in Texas: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Stelara Covered by Humana in Texas Humana requires prior authorization for Stelara (ustekinumab) in Texas, typically with step therapy requirements and specialty pharmacy dispensing. The fastest path: 1) Verify your plan's formulary tier and PA requirements using Humana's drug search tool, 2) Have

How to Get Gamifant (Emapalumab-lzsg) Covered by Humana in Michigan: Complete Forms, Appeals, and Prior Authorization Guide

Quick Answer: Gamifant requires prior authorization through Humana's medical benefit. Submit PA via provider portal with HLH-2004 criteria documentation, conventional therapy failures, and infection screening. If denied, file internal appeal within 65 days, then Michigan DIFS external review within 127 days. Start by calling Humana member services to

How to Get Advate (octocog alfa) Covered by Aetna (CVS Health) in Michigan: Complete Prior Authorization Guide and Appeals Process

Quick Answer: Getting Advate Covered by Aetna in Michigan Advate (octocog alfa) requires prior authorization from Aetna (CVS Health) in Michigan. Your hematologist must submit documentation proving hemophilia A diagnosis, factor VIII levels, and medical necessity through Aetna's electronic portal. If denied, you have internal appeal rights with

How to Get Natpara (Parathyroid Hormone) Covered by Humana in New York: Appeals Guide for Discontinued Drug

Answer Box: Natpara Coverage Status Natpara (parathyroid hormone) is permanently discontinued as of December 31, 2025. Humana automatically denies new Natpara prescriptions because there's no commercial supply. Instead, focus on getting alternative treatments covered like optimized calcium/calcitriol or Yorvipath. For Humana Medicare denials in New York, you

How to Get Vimizim (Elosulfase Alfa) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vimizim Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Vimizim (elosulfase alfa) across all plan types in Michigan. To get approved: (1) Confirm MPS IVA diagnosis with GALNS enzyme testing or genetic results, (2) Submit PA via the UHC Provider Portal with baseline functional measures

Myths vs. Facts: Getting Evkeeza (evinacumab-dgnb) Covered by UnitedHealthcare in California

Answer Box: Quick Facts About UnitedHealthcare Evkeeza Coverage in California Myth: If your doctor prescribes Evkeeza, UnitedHealthcare must cover it automatically. Fact: UnitedHealthcare requires prior authorization for Evkeeza (evinacumab-dgnb), including genetic or clinical confirmation of homozygous familial hypercholesterolemia (HoFH), documentation of prior lipid-lowering therapy trials, and specialist involvement. Most commercial

How to Get Mepsevii (vestronidase alfa-vjbk) Covered by Cigna in Pennsylvania: Complete PA Guide and Appeals Process

Answer Box: Getting Mepsevii Covered by Cigna in Pennsylvania To get Mepsevii (vestronidase alfa-vjbk) covered by Cigna in Pennsylvania, you need: (1) confirmed MPS VII diagnosis with enzyme assay or genetic testing, (2) specialist prescriber (metabolic geneticist or lysosomal storage disorder expert), and (3) prior authorization using Cigna's