Counterforce Health (Page 10)

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Myths vs. Facts: Getting Strensiq (asfotase alfa) Covered by Humana in New Jersey

Answer Box: Getting Strensiq Covered by Humana in New Jersey Strensiq (asfotase alfa) requires prior authorization from Humana and is typically non-formulary, but coverage is possible for pediatric/juvenile-onset hypophosphatasia with proper documentation. Your prescriber must submit both a prior authorization AND formulary exception request with genetic testing results, low

How to Get Photrexa (Riboflavin) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Photrexa Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington (Premera Blue Cross and Regence BlueShield) require prior authorization for Photrexa (riboflavin ophthalmic solution) used in epithelium-off corneal cross-linking for progressive keratoconus. To get approval: (1) Document keratoconus progression with serial

Myths vs. Facts: Getting Tysabri (Natalizumab) Covered by Aetna (CVS Health) in Virginia

Answer Box: Getting Tysabri Covered by Aetna (CVS Health) in Virginia Myth: If your doctor prescribes Tysabri, Aetna automatically covers it. Fact: Aetna requires prior authorization with TOUCH REMS enrollment, JCV antibody testing, baseline MRI, and documented step therapy failures for Crohn's disease. The fastest path to approval

How to Get Xospata (Gilteritinib) Covered by Aetna CVS Health in New York: Complete Appeals Guide

Quick Answer: Getting Xospata (Gilteritinib) Covered by Aetna CVS Health in New York Xospata (gilteritinib) is covered on Aetna formularies as a specialty oncology drug requiring prior authorization, FLT3 mutation testing, and specialty pharmacy dispensing. Your fastest path to approval: 1) Confirm your Aetna plan covers Xospata via the member

Work With Your Doctor to Get Nucala (Mepolizumab) Approved by Humana in Michigan: Complete Provider Collaboration Guide

Answer Box: Getting Nucala Covered by Humana in Michigan Humana requires prior authorization for Nucala (mepolizumab) with specific criteria: blood eosinophils ≥150 cells/μL, severe asthma despite high-dose ICS/LABA therapy, and ≥2 exacerbations requiring systemic steroids annually. Your pulmonologist or allergist must submit documentation via Humana's provider

Myths vs. Facts: Getting Joenja (leniolisib) Covered by Blue Cross Blue Shield in Washington

Answer Box: Getting Joenja (leniolisib) Covered by Blue Cross Blue Shield in Washington Fact: Blue Cross Blue Shield plans in Washington (primarily Premera Blue Cross and Regence BlueShield) require prior authorization for Joenja (leniolisib), but approval is achievable with proper documentation. Key requirements: genetic confirmation of APDS (PIK3CD or PIK3R1

Blue Cross Blue Shield Ohio Coverage Criteria for Venclexta (venetoclax): What Counts as "Medically Necessary"?

Answer Box: Getting Venclexta Covered by BCBS Ohio Blue Cross Blue Shield of Ohio (BCBSOH) requires prior authorization for Venclexta (venetoclax) with specific medical necessity criteria. For CLL/SLL: confirmed diagnosis and age ≥18. For AML: age ≥75 or comorbidities preventing intensive chemotherapy, plus combination therapy. First step today: Contact

Myths vs. Facts: Getting Kuvan (Sapropterin) Covered by Cigna in Florida – Complete Prior Authorization Guide

Answer Box: Getting Kuvan Covered by Cigna in Florida A doctor's prescription doesn't guarantee Cigna coverage for Kuvan (sapropterin dihydrochloride). Prior authorization is mandatory, requiring confirmed PKU diagnosis (ICD-10 E70.0), phenylalanine-restricted diet adherence, elevated Phe levels, and documented BH4 responsiveness (≥20% phenylalanine reduction). Submit via

How to Get Luxturna (Voretigene Neparvovec-rzyl) Covered by Humana in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Luxturna Covered by Humana in Pennsylvania Humana Medicare plans require prior authorization for Luxturna (voretigene neparvovec-rzyl) with specific genetic testing and facility requirements. Key steps: (1) Confirm biallelic RPE65 mutations via authorized lab testing, (2) Schedule evaluation at UPMC Eye Center or CHOP, and (3) Submit prior

How to Get Taltz (Ixekizumab) Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization and Appeals Guide

Aetna CVS Health requires prior authorization (PA) for Taltz (ixekizumab) in New Jersey, including step therapy with TNF inhibitor failure documentation, TB screening within 6 months, and specialist prescription. Submit the Taltz precertification form via fax (1-844-268-7263) or provider portal. If denied, you have 180 days for internal appeals, then