Counterforce Health Team

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

Cigna's Coverage Criteria for Therakos CELLEX Photopheresis in Michigan: What Counts as "Medically Necessary"?

Answer Box: Getting Therakos CELLEX Covered by Cigna in Michigan Cigna requires prior authorization for Therakos CELLEX photopheresis system for CTCL and GVHD treatments. To qualify, you need documented steroid-refractory or progressive disease after standard therapies. Submit via CoverMyMeds ePA or Cigna's precertification portal with diagnosis, prior therapy

How to Get Hetlioz LQ (Tasimelteon) Covered by Blue Cross Blue Shield in Illinois: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Hetlioz LQ Covered by Blue Cross Blue Shield in Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) for Smith-Magenis syndrome in children ages 3-15. The fastest path to approval: (1) Confirm your child's SMS diagnosis with genetic

How to Get Opzelura (Ruxolitinib Cream) Covered by Cigna in New York: Appeals, Forms & State Protections

Quick Answer: Getting Opzelura Covered by Cigna in New York Eligibility: Opzelura (ruxolitinib cream) requires prior authorization from Cigna for atopic dermatitis and vitiligo. Fastest path: Have your dermatologist submit a PA request documenting failed topical steroids and calcineurin inhibitors. First step today: Call the number on your Cigna ID

Oxbryta (Voxelotor) Coverage by UnitedHealthcare in Illinois: FDA Withdrawal Impact and Alternative Treatment Appeals

Answer Box: Oxbryta Coverage Status Oxbryta (voxelotor) was voluntarily withdrawn from the U.S. market in September 2024 due to safety concerns, including increased vaso-occlusive crises and deaths. UnitedHealthcare and all U.S. insurers now deny Oxbryta claims because the drug is no longer available or FDA-approved. If you need