Counterforce Health Team

How to Get Alecensa (alectinib) Covered by Cigna in Texas: Appeals Process, State Laws, and Approval Strategies

Answer Box: Getting Alecensa (alectinib) Covered by Cigna in Texas To get Alecensa (alectinib) approved by Cigna in Texas: Your oncologist must submit a prior authorization request through Express Scripts/Accredo with ALK-positive test results, prior therapy documentation, and medical necessity justification. If denied, you have 180 days to appeal

Renewing Isturisa (Osilodrostat) Approval with Cigna in New Jersey: 2025 Guide to Timelines, Documentation & Appeals

Answer Box: Renewing Isturisa (Osilodrostat) with Cigna in New Jersey Cigna requires prior authorization renewal for Isturisa (osilodrostat) annually or through plan year-end, prescribed by an endocrinologist with documented treatment response. Submit renewal 30-60 days before expiration via EviCore portal with updated cortisol labs, clinical response documentation, and prescriber attestation.

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by Cigna in Texas: Appeals Guide and Medical Necessity Templates

Answer Box: Getting HyperHEP Covered by Cigna in Texas Cigna requires prior authorization for HyperHEP (hepatitis B immune globulin) based on CDC post-exposure prophylaxis guidelines. Submit PA within 24-48 hours of exposure with documentation including incident report, source HBsAg status, and vaccination history. If denied, file Level 1 appeal within

The Complete Checklist to Get Cystadane (betaine anhydrous) Covered by Blue Cross Blue Shield in Illinois: Forms, Appeals, and Approval Strategies

Quick Answer: Getting Cystadane Covered by BCBS Illinois Cystadane (betaine anhydrous) requires prior authorization from Blue Cross Blue Shield of Illinois for all plans. The fastest path to approval: (1) Submit PA through the Carelon Provider Portal with genetic testing confirming homocystinuria (ICD-10 E72.11 or E72.12), elevated homocysteine

How to Get Tysabri (natalizumab) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tysabri Covered by Aetna CVS Health in North Carolina Tysabri (natalizumab) requires prior authorization from Aetna CVS Health with mandatory TOUCH Prescribing Program enrollment, recent JCV antibody testing, and brain MRI documentation. Submit requests via phone (1-855-582-2025), fax (1-855-330-1716), or mail with complete medical records. If denied,

Getting Tagrisso (Osimertinib) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tagrisso Covered by BCBS North Carolina Fastest Path: Tagrisso (osimertinib) requires prior authorization from Blue Cross Blue Shield of North Carolina for EGFR-mutant NSCLC. Your oncologist must document EGFR mutation testing (exon 19 deletion or L858R), disease staging, and any prior TKI failures. Submit PA via CoverMyMeds

How to Get Uptravi (Selexipag) Covered by Humana in Ohio: Prior Authorization Guide with Appeals Process

Quick Answer: Getting Uptravi (Selexipag) Covered by Humana in Ohio Your fastest path to approval: Submit a prior authorization request with documented WHO Group I PAH diagnosis, functional class II-IV status, 6-minute walk test results, and evidence of background therapy plan. If denied, you have 65 days to appeal with

How to Get Therakos CELLEX Photopheresis Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Therakos CELLEX Covered in North Carolina Blue Cross Blue Shield of North Carolina covers Therakos CELLEX photopheresis for FDA-approved uses like cutaneous T-cell lymphoma (CTCL) and steroid-refractory graft-versus-host disease (GVHD), but requires prior authorization. Your doctor submits a PA request through the BCBS NC provider portal with

How to Get Evkeeza (evinacumab-dgnb) Covered by UnitedHealthcare in Washington: Complete Prior Authorization Guide

Quick Answer: Getting Evkeeza Covered in Washington Evkeeza (evinacumab-dgnb) requires prior authorization from UnitedHealthcare OptumRx with no step therapy requirements for homozygous familial hypercholesterolemia (HoFH). Submit PA documentation including HoFH diagnosis (genetic confirmation or clinical phenotype), maximally tolerated lipid-lowering therapy failures, and specialist prescription. If denied, Washington's robust

How to Get Kesimpta (Ofatumumab) Covered by Blue Cross Blue Shield in California: Prior Authorization, Appeals & Cost Savings

Answer Box: Getting Kesimpta Covered by Blue Shield of California Kesimpta (ofatumumab) requires prior authorization from Blue Shield of California for relapsing multiple sclerosis. The fastest path to approval: 1) Submit PA request with MS diagnosis (ICD-10: G35) and documentation of failed/contraindicated alternatives like Betaseron or Copaxone, 2) Obtain