Counterforce Health Team

How to Get Cometriq (cabozantinib) Covered by UnitedHealthcare in Michigan: Complete PA Guide with Forms and Appeals

Getting Cometriq (cabozantinib) covered by UnitedHealthcare in Michigan requires prior authorization for metastatic medullary thyroid carcinoma (MTC) or progressive thyroid cancers after failed step therapy. Submit via the UHC Provider Portal with diagnosis confirmation, or call 866-889-8054. If denied, you have 180 days for internal appeals and 127 days for

How to Get Isturisa (Osilodrostat) Covered by Aetna (CVS Health) in Virginia: Complete Guide with Forms, Appeals, and Timelines

Quick Answer: Getting Isturisa (Osilodrostat) Approved by Aetna (CVS Health) in Virginia Aetna requires prior authorization for Isturisa (osilodrostat) in adults with confirmed Cushing's disease when surgery has failed or is contraindicated. Submit the specialty PA form via Aetna's provider portal or fax to 1-877-269-9916 with

Do You Qualify for Bylvay (odevixibat) Coverage by Blue Cross Blue Shield in Virginia? Decision Tree & Next Steps

Answer Box: To get Bylvay (odevixibat) covered by Blue Cross Blue Shield in Virginia, you need: (1) confirmed PFIC or Alagille syndrome diagnosis from a GI specialist, (2) age 3+ months for PFIC or 12+ months for Alagille, and (3) documentation of symptom severity. Submit prior authorization through your doctor&

Do You Qualify for Ocrevus (Ocrelizumab) Coverage by Cigna in New York? Complete Decision Tree & Appeals Guide

Answer Box: Ocrevus Coverage by Cigna in New York Yes, you likely qualify if you have confirmed relapsing or primary progressive MS and have tried/failed at least one disease-modifying therapy. Cigna requires prior authorization through CoverMyMeds or fax (855-840-1678) with 5-day processing. First step today: Contact your neurologist to

Requirements Checklist to Get Qinlock (ripretinib) Covered by Aetna CVS Health in Virginia

Answer Box: Getting Qinlock (ripretinib) Covered by Aetna CVS Health in Virginia Eligibility: Qinlock requires prior authorization from Aetna CVS Health for fourth-line GIST treatment after documented failure of imatinib, sunitinib, and regorafenib. Fastest path: Submit complete documentation including pathology report, treatment history with outcomes, and medical necessity letter through

How to Get Filsuvez (Birch Triterpenes Topical Gel) Covered by Cigna in Georgia: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Filsuvez Covered by Cigna in Georgia Filsuvez (birch triterpenes topical gel) requires prior authorization through Cigna/Express Scripts for epidermolysis bullosa (EB) wound care. To get approval: 1) Submit PA with confirmed DEB/JEB diagnosis, wound documentation ≥21 days duration, and dermatologist prescription via CoverMyMeds or call

How to Get Revcovi (Elapegademase) Covered by Aetna (CVS Health) in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Revcovi Coverage in Pennsylvania Aetna (CVS Health) requires prior authorization for Revcovi (elapegademase) in Pennsylvania. Your fastest path: 1) Confirm ADA-SCID diagnosis with enzyme/genetic testing, 2) Have your immunologist/hematologist submit PA through Aetna's provider portal with medical necessity letter citing FDA

How to Get Exondys 51 (Eteplirsen) Covered by Cigna in Texas: Complete Prior Authorization Guide

Answer Box: Fastest Path to Exondys 51 Coverage To get Exondys 51 (eteplirsen) covered by Cigna in Texas: Submit prior authorization through CoverMyMeds or fax to (855) 840-1678 with genetic testing confirming exon 51-skipping DMD mutation, 6-minute walk test ≥180 meters, and prescription from a neuromuscular specialist. If denied, you

How to Get Breyanzi (lisocabtagene maraleucel) Covered by UnitedHealthcare in Georgia: Prior Authorization Guide and Appeals Process

Answer Box: Getting Breyanzi Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Breyanzi (lisocabtagene maraleucel) CAR-T therapy through OptumRx. Submit via the UHC Provider Portal with diagnosis documentation, prior therapy failures, and medical necessity justification. If denied, you have 180 days for internal appeals and 60 days for

How to Get Skyrizi (Risankizumab) Covered by Aetna CVS Health in New Jersey: Complete Guide with Forms and Appeals

Answer Box: Getting Skyrizi Covered by Aetna CVS Health in New Jersey Aetna CVS Health requires prior authorization for Skyrizi (risankizumab) with documented TNF inhibitor failure for psoriasis. Submit requests via Availity portal at least 2 weeks in advance. If denied, you have 180 days to appeal internally, then file