Counterforce Health Team

How to Get Abecma (idecabtagene vicleucel) Covered by Blue Cross Blue Shield of Michigan: Complete Approval Guide with Forms and Appeal Scripts

Answer Box: Getting Abecma Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Abecma (idecabtagene vicleucel) through their medical benefit PA program. Submit requests via the Availity portal under "Medical and Pharmacy Benefit Drug Prior Auth" with complete clinical documentation showing relapsed/refractory

How to Get Venclexta (venetoclax) Covered by Horizon Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Venclexta Covered in New Jersey Horizon Blue Cross Blue Shield of New Jersey requires prior authorization (PA) for Venclexta (venetoclax), covering it as a Tier 5 specialty drug for FDA-approved CLL/SLL and AML indications. To get approved: 1. Verify coverage via Horizon's formulary and

How to Get Hemlibra (emicizumab-kxwh) Covered by UnitedHealthcare in Texas: Complete PA Guide with Appeals Timeline

Quick Answer: Getting Hemlibra Approved by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Hemlibra (emicizumab-kxwh) in Texas, with approval based on hemophilia A diagnosis and factor VIII inhibitor status (≥5 Bethesda units for inhibitor-positive patients). Your hematologist must submit documentation through the UnitedHealthcare Provider Portal within 14 days for

How to Get Zanzalintinib (XL092) Covered by Humana in Virginia: Appeals Guide for Investigational Cancer Treatment

Answer Box: Getting Zanzalintinib (XL092) Coverage from Humana in Virginia Zanzalintinib (XL092) is investigational and typically denied by Humana as "not covered outside clinical trials." However, you have three main pathways: 1) Request a formulary exception with strong medical necessity documentation, 2) Apply for Exelixis' compassionate use

How to Get Alecensa (alectinib) Covered by Cigna in Texas: Appeals Process, State Laws, and Approval Strategies

Answer Box: Getting Alecensa (alectinib) Covered by Cigna in Texas To get Alecensa (alectinib) approved by Cigna in Texas: Your oncologist must submit a prior authorization request through Express Scripts/Accredo with ALK-positive test results, prior therapy documentation, and medical necessity justification. If denied, you have 180 days to appeal

Renewing Isturisa (Osilodrostat) Approval with Cigna in New Jersey: 2025 Guide to Timelines, Documentation & Appeals

Answer Box: Renewing Isturisa (Osilodrostat) with Cigna in New Jersey Cigna requires prior authorization renewal for Isturisa (osilodrostat) annually or through plan year-end, prescribed by an endocrinologist with documented treatment response. Submit renewal 30-60 days before expiration via EviCore portal with updated cortisol labs, clinical response documentation, and prescriber attestation.

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by Cigna in Texas: Appeals Guide and Medical Necessity Templates

Answer Box: Getting HyperHEP Covered by Cigna in Texas Cigna requires prior authorization for HyperHEP (hepatitis B immune globulin) based on CDC post-exposure prophylaxis guidelines. Submit PA within 24-48 hours of exposure with documentation including incident report, source HBsAg status, and vaccination history. If denied, file Level 1 appeal within

The Complete Checklist to Get Cystadane (betaine anhydrous) Covered by Blue Cross Blue Shield in Illinois: Forms, Appeals, and Approval Strategies

Quick Answer: Getting Cystadane Covered by BCBS Illinois Cystadane (betaine anhydrous) requires prior authorization from Blue Cross Blue Shield of Illinois for all plans. The fastest path to approval: (1) Submit PA through the Carelon Provider Portal with genetic testing confirming homocystinuria (ICD-10 E72.11 or E72.12), elevated homocysteine

How to Get Tysabri (natalizumab) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tysabri Covered by Aetna CVS Health in North Carolina Tysabri (natalizumab) requires prior authorization from Aetna CVS Health with mandatory TOUCH Prescribing Program enrollment, recent JCV antibody testing, and brain MRI documentation. Submit requests via phone (1-855-582-2025), fax (1-855-330-1716), or mail with complete medical records. If denied,

Getting Tagrisso (Osimertinib) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tagrisso Covered by BCBS North Carolina Fastest Path: Tagrisso (osimertinib) requires prior authorization from Blue Cross Blue Shield of North Carolina for EGFR-mutant NSCLC. Your oncologist must document EGFR mutation testing (exon 19 deletion or L858R), disease staging, and any prior TKI failures. Submit PA via CoverMyMeds