Counterforce Health Team

How to Get Rezlidhia (olutasidenib) Covered by Aetna (CVS Health) in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Rezlidhia (olutasidenib) Covered by Aetna (CVS Health) in Pennsylvania Fastest path to approval: Submit prior authorization through CVS Caremark or Aetna provider portal with IDH1 mutation test results, AML diagnosis confirmation, and documented failure of preferred alternatives. If denied, request peer-to-peer review within 180 days, then file

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield in Pennsylvania: Appeals Guide and Forms

Answer Box: Getting Enhertu Covered by Blue Cross Blue Shield in Pennsylvania Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. Submit HER2 testing results, prior therapy failure documentation, and medical necessity letter via your BCBS provider portal or PA fax line. If denied,

How to Get Zolgensma Covered by Humana in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in Georgia Fastest path: Submit prior authorization through Humana's medical benefit using HCPCS J3399 with complete genetic testing (SMN1 mutation confirmation), AAV9 antibody results, and specialist letter of medical necessity. Standard decision within 14-30 days; expedited within 72 hours if delay

The Requirements Checklist to Get Brineura (Cerliponase Alfa) Covered by Blue Cross Blue Shield in Texas

Answer Box: Getting Brineura Covered in Texas Blue Cross Blue Shield of Texas requires prior authorization for Brineura (cerliponase alfa) with strict clinical criteria including confirmed CLN2 diagnosis, specialized neurologist prescription, and documented ambulatory function. Submit via their medical PA portal with genetic/enzyme testing, baseline CLN2 scores, and medical

Myths vs. Facts: Getting Cresemba (Isavuconazole) Covered by Aetna (CVS Health) in Illinois - Complete Appeals Guide

Answer Box: Getting Cresemba Covered by Aetna in Illinois Cresemba (isavuconazole) requires prior authorization from Aetna (CVS Health) in Illinois. You'll need documented invasive aspergillosis or mucormycosis, evidence of voriconazole failure/intolerance for aspergillosis cases, and typically an infectious disease specialist consultation. If denied, Illinois provides strong appeal

How to Get Galafold (Migalastat) Covered by Humana in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Galafold Covered by Humana in North Carolina Galafold (migalastat) requires prior authorization from Humana for adults with Fabry disease and confirmed amenable GLA variants. First step: Have your specialist submit a PA request with genetic testing showing an amenable variant, clinical documentation of Fabry symptoms, and why

The Requirements Checklist to Get Pomalyst (Pomalidomide) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Fast Track to Pomalyst Coverage in North Carolina Aetna (CVS Health) requires prior authorization for Pomalyst (pomalidomide) with documented failure of lenalidomide plus a proteasome inhibitor. Submit PA via Availity portal with REMS enrollment proof, treatment timeline, and oncology notes. If denied, file internal appeal within 180 days,

How to Get Xywav Covered by UnitedHealthcare in North Carolina: PA Requirements, Appeals Process & State Protections

Answer Box: Getting Xywav Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Xywav with step therapy failures and REMS enrollment. In North Carolina, you have strong appeal rights including expedited external review through Smart NC. Start today: 1) Enroll in XYWAV/XYREM REMS program, 2) Gather sleep

How to Get Evrysdi (Risdiplam) Covered by Cigna in Texas: Complete PA Guide and Appeal Process

Answer Box: Getting Evrysdi (Risdiplam) Covered by Cigna in Texas Cigna requires prior authorization for Evrysdi (risdiplam) with genetic testing, motor assessment, and specialist involvement. Submit electronically via CoverMyMeds or Accredo's portal for fastest approval (72 hours). If denied, file internal appeal within 180 days, then Texas external

How to Get Tegsedi (inotersen) Covered by UnitedHealthcare in Texas: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Tegsedi (inotersen) Approved by UnitedHealthcare in Texas Quick Path to Coverage: UnitedHealthcare requires prior authorization for Tegsedi (inotersen) for hereditary transthyretin amyloidosis with polyneuropathy. You'll need: (1) confirmed hATTR diagnosis with TTR mutation, (2) REMS program enrollment for patient, prescriber, and pharmacy, and (3) baseline