Counterforce Health Team

How to Get Ocrevus Covered by UnitedHealthcare in North Carolina: PA Forms, Appeals, and Approval Timeline

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in North Carolina UnitedHealthcare covers Ocrevus (ocrelizumab) in North Carolina when prior authorization criteria are met: confirmed MS diagnosis (relapsing forms or primary progressive), documented treatment history, and clinical necessity. No universal step therapy requirement exists in UHC's national policy, but

Do You Qualify for Symdeko/Symkevi Coverage by Aetna CVS Health in Virginia? Decision Tree & Next Steps

Quick Answer: Your Path to Symdeko/Symkevi Coverage in Virginia Eligibility: You likely qualify if you're ≥6 years old with cystic fibrosis and documented F508del mutations (homozygous or with another responsive mutation). Fastest approval: Have your CF specialist submit prior authorization with genotype report, clinic notes, and medical

How to Get Jaypirca (pirtobrutinib) Covered by Humana in Texas: Appeals, Forms, and Renewal Guide

Quick Answer: Getting Jaypirca Covered by Humana in Texas Jaypirca (pirtobrutinib) typically requires prior authorization from Humana for both Medicare Advantage and commercial plans in Texas. The fastest path: 1) Have your oncologist submit a prior authorization request with documentation of prior BTK inhibitor failure and current disease status, 2)

How to Get Soliris (Eculizumab) Covered by Blue Cross Blue Shield of Michigan: Complete Guide with Forms, Timelines, and Appeal Scripts

Answer Box: Getting Soliris Covered by BCBS Michigan To get Soliris (eculizumab) covered by Blue Cross Blue Shield of Michigan, you'll need prior authorization through their NovoLogix system. Since July 2024, BCBS Michigan requires patients to try Empaveli (pegcetacoplan) first for most indications unless contraindicated. The fastest path:

How to Get iLink® Corneal Cross-Linking Covered by Cigna in Georgia: Complete Timeline, Forms & Appeals Guide

Answer Box: Getting iLink® Covered by Cigna in Georgia Cigna typically covers FDA-approved iLink® epithelium-off corneal cross-linking for progressive keratoconus when prior authorization criteria are met. Standard approval takes 5 business days; expedited review within 72 hours if vision-threatening. First step: Have your ophthalmologist document keratoconus progression (≥1.0 D

How to Get Daybue (trofinetide) Covered by Blue Cross Blue Shield California: Forms, Appeals, and State Protections

Answer Box: Getting Daybue Covered in California Blue Shield of California requires prior authorization for Daybue (trofinetide) with specific clinical criteria: confirmed Rett syndrome with MECP2 mutation, age ≥2 years, and neurologist prescriber. Initial approval covers 3 months, renewals require evidence of clinical benefit. If denied, California's Independent

How to Get Juxtapid (lomitapide) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Juxtapid (lomitapide) Covered by Humana in Washington Fastest path to approval: Submit prior authorization through Humana's electronic PA portal with genetic confirmation of HoFH, documented failure of maximally tolerated standard lipid-lowering therapy, and baseline liver function tests. If denied, file internal appeal within 65 days,

How to Get Mavenclad (Cladribine Tablets) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad (Cladribine Tablets) Covered by Humana in Washington Eligibility: Adults with relapsing forms of multiple sclerosis (including active secondary progressive MS) who meet lymphocyte count requirements and have tried or cannot use preferred disease-modifying therapies. Fastest Path: Your neurologist submits a prior authorization through Humana's

How to Get Gilenya (fingolimod) Covered by UnitedHealthcare in Virginia: Appeal Templates & Timelines

Answer Box: Your Fastest Path to Gilenya Coverage UnitedHealthcare requires prior authorization for Gilenya (fingolimod) with step therapy requirements and safety documentation. If denied, you have 180 days to file an internal appeal, then 120 days for Virginia external review through the State Corporation Commission. Start today: 1) Request peer-to-peer

How to Get Tavalisse (Fostamatinib) Covered by Aetna CVS Health in Virginia: Complete Appeals Guide with Forms and Scripts

Answer Box: Fastest Path to Tavalisse Coverage To get Tavalisse (fostamatinib) covered by Aetna CVS Health in Virginia, you'll need prior authorization showing chronic ITP diagnosis, failed prior therapies (steroids, IVIG), and hematologist involvement. Submit PA via Availity provider portal with complete clinical documentation. If denied, you have