Counterforce Health Team

How to Get Vimizim (elosulfase alfa) Covered by Aetna (CVS Health) in California: Complete Prior Authorization and Appeals Guide

Getting Vimizim (elosulfase alfa) covered by Aetna (CVS Health) in California requires prior authorization with confirmed MPS IVA diagnosis, specialist prescription, and baseline functional assessments. Submit documentation via Aetna's provider portal or call 1-888-632-3862 for PA forms. If denied, file an internal appeal within 180 days, then request

How to Get Vyondys 53 (golodirsen) Covered by Cigna in New York: Complete Prior Authorization Guide

Answer Box: To get Vyondys 53 (golodirsen) covered by Cigna in New York, you need prior authorization with genetic testing confirming an exon 53-skippable DMD mutation, a neurologist's prescription, and baseline functional assessments. Submit through Express Scripts provider portal or call 1-800-882-4462. Standard review takes 2-7 business days;

How to Get Myozyme (Alglucosidase Alfa) Covered by Cigna in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Myozyme (Alglucosidase Alfa) Covered by Cigna in Ohio Cigna requires prior authorization for Myozyme (alglucosidase alfa) in Ohio, typically approved within 5-7 business days when complete documentation is submitted. Essential requirements include confirmed Pompe disease diagnosis (enzyme/genetic testing), metabolic specialist prescriber, and dosing ≤20 mg/kg

How to Get Hemgenix (etranacogene dezaparvovec) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hemgenix Covered by Aetna CVS Health in Virginia Hemgenix (etranacogene dezaparvovec) requires prior authorization from Aetna CVS Health. Adults with severe hemophilia B (≤2% Factor IX) on prophylaxis or with serious bleeding history can qualify. Submit complete documentation including Factor IX levels, inhibitor tests, bleeding history, and

Renewing Kineret (anakinra) Approval with UnitedHealthcare in North Carolina: 2025 Timeline, Forms, and Appeal Guide

Answer Box: Kineret Renewal with UnitedHealthcare in North Carolina UnitedHealthcare requires annual prior authorization renewal for Kineret (anakinra) managed through OptumRx. Start the renewal process 60 days before your current authorization expires by scheduling a follow-up visit with your specialist. Submit the complete renewal packet 30 days before expiration to

Get Voydeya (Danicopan) Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide

Answer Box: Getting Voydeya (danicopan) covered by Aetna CVS Health in Florida requires prior authorization proving you have PNH with extravascular hemolysis despite C5 inhibitor therapy. Fastest path: Have your hematologist submit PA via CVS Caremark's electronic portal with flow cytometry results, current C5 inhibitor details, and labs

How to Get Jynarque (Tolvaptan) Covered by Blue Cross Blue Shield of Michigan: Complete Guide to Prior Authorization, Appeals, and Medical Necessity

Answer Box: Getting Jynarque Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Jynarque (tolvaptan) with strict criteria: confirmed ADPKD diagnosis, Mayo Class 1C-1E rapid progression, eGFR ≥25 mL/min/1.73m², and REMS enrollment. First step today: Have your nephrologist obtain the BCBSM Jynarque PA

How to Get Lamzede (velmanase alfa-tycv) Covered by Humana in Illinois: Complete PA Guide and Appeal Process

Answer Box: Fastest Path to Lamzede Coverage Humana requires prior authorization for Lamzede (velmanase alfa-tycv) with strict medical necessity criteria. You'll need: confirmed alpha-mannosidosis diagnosis (enzyme activity <10% normal + biallelic MAN2B1 variants), documented non-CNS manifestations, baseline functional tests (6-minute walk test, pulmonary function), and specialist letter. Standard

How to Get Berinert (C1-Esterase Inhibitor) Covered by Cigna in North Carolina: Complete PA Guide with Appeal Scripts

Quick Answer: To get Berinert covered by Cigna in North Carolina, you'll need prior authorization with documented HAE diagnosis (low C4 and C1-INH levels), ICD-10 code D84.1, and prescription by an allergist/immunologist. Submit through Cigna's provider portal or Accredo specialty pharmacy. If denied, file

How to Get Acthar Gel Covered by Humana in New York: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Acthar Gel Covered by Humana in New York Humana requires prior authorization for Acthar Gel under their Corticotropin Products policy (effective 2024). For approval, you need: (1) documented covered indication like infantile spasms or MS exacerbations, (2) proof of corticosteroid failure/intolerance except for infantile spasms, and