Counterforce Health Team

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

How to Get Defitelio (Defibrotide) Covered by Blue Cross Blue Shield in New Jersey: Complete Timeline Guide and Appeal Templates

Answer Box: Getting Defitelio Covered in New Jersey Defitelio (defibrotide) requires prior authorization from Horizon Blue Cross Blue Shield of New Jersey for hepatic VOD/SOS with organ dysfunction after HSCT. Submit urgent PA requests within 24 hours for life-threatening cases. If denied, file internal appeals within 180 days, then

How to Get Epidiolex (Cannabidiol) Covered by UnitedHealthcare in New Jersey: Complete Approval Guide with Forms and Timelines

Answer Box: Getting Epidiolex Covered by UnitedHealthcare in New Jersey Epidiolex (cannabidiol) requires prior authorization from UnitedHealthcare for FDA-approved seizure disorders (Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex). Most plans require documentation of at least two failed antiepileptic drugs and specialist involvement. If denied, New Jersey offers external review

Denied for Firazyr (Icatibant) by UnitedHealthcare in New Jersey? How to Appeal (Templates & Timelines)

Answer Box: UnitedHealthcare requires prior authorization for Firazyr (icatibant injection) with specific HAE diagnosis documentation, specialist prescribing, and proof of acute-only use. If denied, you have three steps: (1) Request peer-to-peer review within 48 hours, (2) File internal appeal within 180 days, (3) Submit external appeal to New Jersey'

How to Get Daybue (trofinetide) Covered by Aetna (CVS Health) in New York: Complete PA Guide, Forms & Appeal Process

Answer Box: Your Fastest Path to Approval To get Daybue (trofinetide) covered by Aetna (CVS Health) in New York, you need prior authorization with genetic confirmation of Rett syndrome. Aetna covers Daybue as a specialty drug when criteria are met: confirmed MECP2 pathogenic mutation, patient age ≥2 years, and specialist

How to Get Dupixent (dupilumab) Covered by Cigna in Georgia: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Dupixent (dupilumab) covered by Cigna in Georgia requires prior authorization with documented diagnosis severity, failed step therapy (topical steroids for atopic dermatitis, inhaled steroids for asthma), and specialist involvement. Submit PA through Cigna provider portal with clinical notes showing disease impact and prior treatment failures. If denied,