Counterforce Health Team

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

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

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

Work With Your Doctor to Get HyperHEP (Hepatitis B Immune Globulin) Approved by Humana in New Jersey

Answer Box: Getting HyperHEP Approved by Humana in New Jersey HyperHEP (hepatitis B immune globulin) requires prior authorization from Humana Medicare Advantage plans and may be covered under Medicare Part B (not Part D) when given for post-exposure prophylaxis in clinical settings. Your fastest path: Have your doctor submit a

How to Get HyperHEP Covered by Humana in California: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting HyperHEP Covered by Humana in California Humana requires prior authorization for HyperHEP (hepatitis B immune globulin) in California. Submit documentation of exposure details, patient immunity status, and timing within 24 hours (up to 7 days) via Humana's provider portal. For denials, file an internal appeal

How to Get Humate-P Covered by Blue Cross Blue Shield in Washington: Complete Guide to Prior Authorization, Appeals, and Home Infusion

Answer Box: Humate-P (antihemophilic factor/vWF complex) requires prior authorization from Blue Cross Blue Shield plans in Washington, including Premera and Regence. First step: Have your hematologist submit a PA request with VWD subtype documentation, DDAVP trial results, and weight-based dosing calculations through your plan's provider portal. Standard

How to Get Elelyso (taliglucerase alfa) Covered by Cigna in Georgia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Elelyso (taliglucerase alfa) Covered by Cigna in Georgia Eligibility: Cigna typically covers Elelyso for confirmed Type 1 Gaucher disease patients ≥4 years with prior authorization and often requires step therapy (trying Cerezyme or VPRIV first). Fastest path: Have your specialist submit a complete prior authorization through Cigna&

A Realistic Idelvion Approval Scenario with UnitedHealthcare in Ohio (From Request to Yes)

Answer Box: Getting Idelvion Covered by UnitedHealthcare in Ohio Quick Path to Approval: UnitedHealthcare requires prior authorization for Idelvion (albutrepenonacog alfa) through OptumRx. Most approvals succeed with complete documentation of hemophilia B diagnosis, factor IX levels <40%, bleeding history, and specialist prescriber involvement. If denied, Ohio residents have strong

Ultomiris (Ravulizumab) Approval with UnitedHealthcare in Virginia: Answers to the Most Common Questions

Answer Box: Getting Ultomiris Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Ultomiris (ravulizumab) with step therapy typically mandating prior eculizumab trial first. Submit PA via UnitedHealthcare provider portal with diagnosis confirmation, REMS vaccination records, and clinical rationale. Standard decisions take up to 72 hours; expedited reviews (when

How to Get Trikafta Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Quick Answer: Trikafta requires prior authorization from UnitedHealthcare for CF patients ≥2 years with documented CFTR mutations (like F508del). Submit PA through your CF specialist with genetic testing, baseline labs, and medical necessity letter to Optum Specialty Pharmacy. If denied, appeal internally within 180 days, then file external review with