Counterforce Health Team

Do You Qualify for Firdapse (Amifampridine) Coverage by Cigna in New Jersey? Decision Tree & Next Steps

Quick Answer: Your Path to Firdapse Coverage Most likely eligible: If you have confirmed LEMS with EMG evidence, are ≥6 years old, have no seizure history, and a neurologist's prescription. First step: Have your neurologist submit prior authorization through CoverMyMeds with complete diagnostic documentation. If denied: Cigna allows

How to Get Filsuvez (Birch Triterpenes Topical Gel) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Filsuvez Coverage Cigna requires prior authorization for Filsuvez (birch triterpenes topical gel) in New Jersey. Your fastest path: 1) Have your dermatologist submit a Cigna PA form with dystrophic EB diagnosis, wound photos, and cancer screening results. 2) If denied, file an internal appeal within

How to Get Cerezyme (Imiglucerase) Covered by Aetna CVS Health in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cerezyme Covered by Aetna CVS Health in Washington Cerezyme (imiglucerase) requires prior authorization from Aetna CVS Health in Washington, with many plans requiring step therapy (trying Elelyso first). The fastest path to approval: Have your Gaucher specialist complete Aetna's Cerezyme precertification form with confirmed Type

The Requirements Checklist to Get Strimvelis (Autologous CD34+ ADA-SCID Gene Therapy) Covered by Blue Cross Blue Shield in Pennsylvania

Answer Box: Fast Track to Approval Getting Strimvelis (autologous CD34+ ADA-SCID gene therapy) covered by Blue Cross Blue Shield in Pennsylvania requires prior authorization via medical exception due to non-FDA approval and international treatment location (SR-TIGET, Milan). Success depends on: (1) confirmed ADA-SCID diagnosis with biallelic ADA mutations and enzyme

How to Get Kymriah (tisagenlecleucel) Covered by Blue Cross Blue Shield of North Carolina: Complete Guide with Forms, Deadlines & Appeal Scripts

Answer Box: Getting Kymriah Covered by Blue Cross NC Blue Cross Blue Shield of North Carolina requires prior authorization for Kymriah (tisagenlecleucel) CAR-T therapy. Your fastest path: Submit via Availity portal with CD19-positive pathology, prior therapy documentation, and treatment at a certified CAR-T center. Appeals success rate is high when

How to Get Gilenya (fingolimod) Covered by Blue Cross Blue Shield in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gilenya (fingolimod) Covered by Blue Cross Blue Shield in Ohio Fastest path to approval: Submit a comprehensive prior authorization through your BCBS Ohio provider portal including: 1) Complete prior MS therapy history with failure documentation, 2) Required safety tests (EKG, ophthalmologic exam, labs), and 3) First-dose monitoring

UnitedHealthcare's Coverage Criteria for Filspari (sparsentan) in Florida: What Counts as "Medically Necessary"?

Answer Box: UnitedHealthcare requires prior authorization for Filspari (sparsentan) with specific medical necessity criteria: biopsy-proven primary IgA nephropathy, nephrologist involvement, REMS enrollment, and documented proteinuria ≥0.5-1.0 g/day. Step therapy typically requires maximally tolerated ACE inhibitor/ARB first. Fastest approval path: (1) Complete REMS certification for prescriber and

Do You Qualify for Alprolix Coverage by Humana in Michigan? Complete Decision Tree & Appeals Guide

Answer Box: Your Path to Alprolix Coverage Most hemophilia B patients qualify for Alprolix coverage through Humana in Michigan, but prior authorization is required. You'll need: confirmed hemophilia B diagnosis (factor IX ≤2%), board-certified hematologist prescription, negative inhibitor screen, and documented bleeding history. First step today: Contact a

Lowering Out-of-Pocket Costs for Ferriprox (Deferiprone) with UnitedHealthcare in Washington: Complete Coverage & Savings Guide

Answer Box: Getting Ferriprox Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Ferriprox (deferiprone) with no mandatory step therapy, but it's typically placed on Tier 5 specialty with 25-40% coinsurance. Fastest path: 1) Enroll in Chiesi Total Care for copay assistance (commercial plans only), 2) Have

How to Get Bylvay (odevixibat) Covered by Humana in Virginia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Bylvay (odevixibat) Covered by Humana in Virginia Humana Medicare Advantage plans in Virginia typically cover Bylvay as a specialty Part D drug but require prior authorization. If denied, you have 65 days to file a Part D appeal (redetermination). Humana must respond within 7 days for standard