Counterforce Health Team

How to Renew Fabrazyme (Agalsidase Beta) Coverage with Humana in North Carolina: 2025 Requirements & Timeline

Answer Box: Renewing Fabrazyme Coverage with Humana in North Carolina For Humana Medicare Advantage members: Start renewal 30 days before your current authorization expires. Submit via Humana's electronic portal with updated clinical documentation showing ongoing benefit. For commercial Humana plans: You may also use North Carolina's

Myths vs. Facts: Getting Crysvita (burosumab) Covered by Humana in Florida – Prior Authorization & Appeals Guide

Answer Box: Getting Crysvita (burosumab) Covered by Humana in Florida Quick Facts: Humana requires prior authorization for Crysvita (burosumab) with step therapy through oral phosphate plus vitamin D analogs first. The fastest path: (1) Get your endocrinologist to document failed conventional therapy and genetic/biochemical XLH confirmation, (2) Submit Humana&

How to Get Crysvita (burosumab) Covered by Cigna in Ohio: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Crysvita Covered by Cigna in Ohio Crysvita (burosumab) requires prior authorization from Cigna in Ohio, typically placed on Tier 4-5 specialty with 20-33% coinsurance. You'll need genetic confirmation (PHEX mutation or elevated FGF23), low baseline serum phosphorus, and specialist prescriber. Submit PA through Cigna'

How to Get Translarna (Ataluren) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Translarna Coverage Through UnitedHealthcare in Michigan Translarna (ataluren) is not FDA-approved and generally excluded by UnitedHealthcare, but coverage may be possible through formulary exceptions. Your fastest path: 1) Verify your plan type and referral needs via the member portal, 2) Have a neuromuscular specialist submit a comprehensive

Myths vs. Facts: Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Blue Cross Blue Shield in Michigan

Answer Box: Getting Hemgenix Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Hemgenix and mandates trying Beqvez first for most commercial members as of November 2024. Submit medical drug PA through OncoHealth via Availity, including hemophilia B diagnosis, failed prophylaxis history, and Beqvez trial documentation.

Work With Your Doctor to Get Koselugo (Selumetinib) Approved by UnitedHealthcare in Ohio: Complete Provider Collaboration Guide

Answer Box: Getting Koselugo Covered by UnitedHealthcare in Ohio Koselugo (selumetinib) requires prior authorization from UnitedHealthcare for pediatric patients ≥2 years with NF1 plexiform neurofibromas. Your doctor must submit clinical documentation proving NF1 diagnosis, inoperable symptomatic tumors, and baseline safety evaluations. If denied, you have 180 days for internal appeals,

Myths vs. Facts: Getting Onpattro (patisiran) Covered by Blue Cross Blue Shield in California

Answer Box: Onpattro Coverage with Blue Shield California Getting Onpattro (patisiran) covered by Blue Shield of California requires prior authorization with genetic TTR mutation proof, neurologist evaluation, and ICD-10 code E85.1 documentation. Submit via AuthAccel portal with clinical records showing hATTR polyneuropathy and functional status. If denied, file internal

Work With Your Doctor to Get Vyondys 53 (Golodirsen) Approved by Aetna CVS Health in Georgia

Quick Answer: Getting Vyondys 53 Covered by Aetna CVS Health in Georgia To get Vyondys 53 (golodirsen) approved by Aetna CVS Health in Georgia, you'll need: (1) genetic testing confirming DMD with exon 53-amenable mutation, (2) specialist documentation of medical necessity, and (3) baseline functional assessments. Submit through

How to Get Lamzede (Velmanase Alfa-Tycv) Approved by Cigna in California: Complete Prior Authorization Guide

Answer Box: Getting Lamzede Covered by Cigna in California Cigna requires prior authorization for Lamzede (velmanase alfa-tycv) in California. Submit via eviCore, CoverMyMeds, or Accredo's iAssist with confirmed alpha-mannosidosis diagnosis (enzyme/genetic testing), specialist letter, and clinical documentation. Standard review: 5 business days; expedited: 24 hours for urgent

How to Get Zolgensma Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization through OptumRx for Zolgensma (onasemnogene abeparvovec-xioi) with strict clinical criteria: genetic confirmation of bi-allelic SMN1 mutations, age under 2 years, anti-AAV9 antibody titer ≤1:50, and documented steroid protocol. If denied, North Carolina residents can appeal