Counterforce Health Team

Counterforce Health Team

How to Get Gattex (Teduglutide) Covered by UnitedHealthcare in California: Appeals, Forms & Timelines

Answer Box: Getting Gattex Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Gattex (teduglutide) with strict medical necessity criteria: documented short bowel syndrome, ≥12 months of parenteral nutrition dependence (≥3 days/week), recent colonoscopy, and specialist involvement. If denied, California residents can appeal internally, then request an Independent
6 min read

Renewing Sumavel DosePro (Sumatriptan Injection, Needle-Free) Approval with Blue Cross Blue Shield in North Carolina: Annual Requirements & Timeline

Answer Box: Renewing Your Sumavel DosePro Authorization Blue Cross Blue Shield of North Carolina typically requires annual prior authorization renewal for Sumavel DosePro (sumatriptan injection, needle-free). Start the renewal process 60-90 days before your current approval expires to avoid coverage gaps. You'll need updated clinical documentation showing continued
7 min read

How to Get Haegarda (C1-Esterase Inhibitor) Covered by Humana in Ohio: Complete PA Guide and Appeal Scripts

Answer Box: Getting Haegarda Covered by Humana in Ohio Fastest path to approval: Humana requires prior authorization for Haegarda (C1-esterase inhibitor, SC) with confirmed hereditary angioedema diagnosis (ICD-10 D84.1), documented C4/C1-INH lab abnormalities, and specialist prescriber. Submit PA through Humana's provider portal with complete clinical documentation.
6 min read

How to Get Palynziq (pegvaliase-pqpz) Covered by Cigna in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Palynziq (pegvaliase-pqpz) Covered by Cigna in Pennsylvania Cigna requires prior authorization for Palynziq with strict criteria: confirmed PKU, age ≥18, blood phenylalanine ≥600 µmol/L despite optimized diet, REMS enrollment, and epinephrine prescription. First step: Have your metabolic specialist submit a comprehensive PA request with baseline Phe
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How to Get Xywav Covered by UnitedHealthcare in Washington: Complete PA Guide & Appeal Steps

Answer Box: Getting Xywav Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Xywav (calcium-magnesium-potassium-sodium oxybates) with specific medical documentation and REMS enrollment. The fastest path: (1) Complete REMS enrollment at XYWAVXYREMREMS.com, (2) Submit PA via UHC provider portal with sleep study results and prior therapy documentation, (3)
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How to Get Tepezza (Teprotumumab) Covered by Cigna in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tepezza Approved by Cigna in Virginia Cigna requires prior authorization for Tepezza (teprotumumab) in Virginia. Your fastest path: Have your ophthalmologist or endocrinologist submit a PA request with documented moderate-to-severe thyroid eye disease (TED), including objective measurements and functional impact. If denied, you have 180 days to
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How to Get Brineura (cerliponase alfa) Covered by UnitedHealthcare in New York: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Brineura Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Brineura (cerliponase alfa) with strict clinical criteria: confirmed CLN2 diagnosis, age ≥3 years, baseline motor/language scores ≥1, and treatment at a qualified neurosurgical center. If denied, you have 180 days for internal appeals, then
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How to Get Lutathera Covered by Humana in California: Prior Authorization Forms, Appeal Process & Success Strategies

Answer Box: Getting Lutathera Covered by Humana in California Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Humana and is covered under Medicare Part B as a medical benefit. Key requirements include SSTR-positive PET imaging and documented failure/progression on somatostatin analogs like octreotide or lanreotide. If denied, California residents
7 min read