Counterforce Health Team

How to Get Juxtapid (lomitapide) Covered by Humana in Georgia: A Complete Step-by-Step Guide

Answer Box: Getting Juxtapid (lomitapide) Covered by Humana in Georgia Humana requires prior authorization for Juxtapid (lomitapide) with strict criteria: confirmed homozygous familial hypercholesterolemia (HoFH), failure of maximally tolerated statin plus ezetimibe and PCSK9 inhibitor, and specialist prescribing. First step: Gather genetic testing results or clinical HoFH documentation, complete treatment

Renewing Vitrakvi (Larotrectinib) Approval with Humana in Texas: Timeline, Documentation, and Bridge Options

Answer Box: Renewing Vitrakvi with Humana in Texas Humana Medicare requires prior authorization renewal for Vitrakvi (larotrectinib) every 6-12 months. Submit renewal 2-4 weeks before expiration with updated imaging showing response/stable disease, oncology notes, and liver function tests. If approval lapses, request a 31-day emergency supply under Humana'

How to Get Abecma (idecabtagene vicleucel) Covered by Blue Cross Blue Shield of North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Abecma Covered by Blue Cross Blue Shield of North Carolina Abecma (idecabtagene vicleucel) requires prior authorization from Blue Cross Blue Shield of North Carolina for adults with relapsed/refractory multiple myeloma after ≥2 prior therapies. Your fastest path to approval: (1) Verify you have a state-regulated BCBS

Getting Busulfex (Busulfan Injection) Covered by UnitedHealthcare in Illinois: Prior Authorization, Appeals, and Medical Necessity Requirements

Quick Answer: Getting Busulfex Covered in Illinois UnitedHealthcare requires prior authorization for Busulfex (busulfan injection, J0594) when used as outpatient chemotherapy for transplant conditioning. For fastest approval: (1) Submit PA via UHC Provider Portal with transplant protocol and FDA-labeled indication documentation, (2) Request expedited review if transplant timing is critical,

How to Get Orfadin (Nitisinone) Covered by Blue Cross Blue Shield in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Orfadin Covered by Blue Cross Blue Shield in Texas Blue Cross Blue Shield of Texas covers Orfadin (nitisinone) as a specialty drug requiring prior authorization for hereditary tyrosinemia type 1 (HT-1). The fastest path to approval: (1) Have your metabolic specialist submit PA with confirmed HT-1 diagnosis

How to Get Fabrazyme (agalsidase beta) Covered by UnitedHealthcare in New York: Complete PA and Appeals Guide

Answer Box: Quick Start Guide Is Fabrazyme covered by UnitedHealthcare in New York? Yes, but requires prior authorization and specialist documentation. Fastest path: Have your Fabry specialist submit PA through the UnitedHealthcare provider portal with genetic testing, enzyme levels, and medical necessity letter. Start today: Call UnitedHealthcare at the number

How to Get Tavalisse Covered by Humana in Illinois: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Tavalisse Covered by Humana in Illinois Tavalisse (fostamatinib) is typically non-formulary under Humana plans in Illinois, requiring a formulary exception plus prior authorization. You'll need: (1) A hematologist prescriber with documented ITP diagnosis and platelet count <30,000/µL, (2) Evidence of failed prior

How to Renew Nourianz (Istradefylline) Coverage with Blue Cross Blue Shield in Ohio: Annual Requirements and Timeline

Answer Box: Blue Cross Blue Shield plans in Ohio typically require annual prior authorization renewal for Nourianz (istradefylline), with reapproval depending on documented continued benefit and ongoing use with carbidopa/levodopa. Start the renewal process 30-60 days before expiration by scheduling a follow-up visit to document objective response (reduced "

How to Get Jaypirca (Pirtobrutinib) Covered by UnitedHealthcare in New York: PA Requirements, Appeals, and State Protections

Answer Box: Getting Jaypirca Covered by UnitedHealthcare in New York Jaypirca (pirtobrutinib) requires prior authorization from UnitedHealthcare with documented failure of or contraindication to other BTK inhibitors. In New York, you have strong appeal rights including 24-72 hour expedited external reviews for urgent denials. Start today by: 1) Having your

How to Get Thiola / Thiola EC (tiopronin) Covered by Blue Cross Blue Shield Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Thiola/Thiola EC Covered in Texas Blue Cross Blue Shield of Texas (BCBSTX) covers Thiola/Thiola EC (tiopronin) as a non-preferred specialty drug requiring prior authorization for cystinuria patients. Coverage requires confirmed diagnosis (ICD-10 E72.01), documented failure of conservative therapy (high fluid intake + alkalinization), and specialist