Counterforce Health (Page 10)

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Work With Your Doctor to Get Cystadane (Betaine Anhydrous) Approved by Cigna in California: Complete Provider Collaboration Guide

Quick Answer: Getting Cystadane (Betaine Anhydrous) Covered by Cigna in California Cystadane (betaine anhydrous) requires Cigna prior authorization with genetic confirmation, elevated homocysteine levels, and vitamin co-therapy documentation. Your physician must submit medical necessity evidence through Cigna's provider portal within 72 hours (24 hours expedited). If denied, California&

The Requirements Checklist to Get Brensocatib (BRINSUPRI) Covered by Cigna in Michigan

Answer Box: Getting Started in Michigan Cigna requires prior authorization for Brensocatib (BRINSUPRI) with step therapy through macrolide antibiotics. Your pulmonologist submits via CoverMyMeds or fax (866-873-8279) with CT scan confirming bronchiectasis, documented exacerbations (≥2/year for adults), and failed macrolide trials. Standard approval takes 5-10 business days. If denied,

How to Get Uptravi (Selexipag) Covered by Humana in Georgia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Uptravi Covered by Humana in Georgia Humana requires prior authorization for Uptravi (selexipag) for pulmonary arterial hypertension. Your fastest path: Have your PAH specialist submit documentation showing WHO Group I PAH diagnosis, functional class II-IV status, and trials of two prior PAH drug classes. If denied, you

How to Get Strensiq (asfotase alfa) Covered by Humana in Ohio: PA Forms, Appeals, and Approval Strategy

Answer Box: Getting Strensiq Covered by Humana in Ohio Strensiq (asfotase alfa) is covered by select Humana plans in Ohio as a Tier 4 specialty drug with dispensing limits. To get approval: 1) Confirm pediatric-onset hypophosphatasia (HPP) with genetic testing showing ALPL mutation and low alkaline phosphatase levels, 2) Submit

How to Get Mavenclad (Cladribine Tablets) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered by Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Mavenclad (cladribine tablets) with documented failure of ≥2 prior disease-modifying therapies, lymphocyte count ≥800 cells/μL, and neurologist prescribing. Submit PA via Availity portal or fax 1-866-249-6155. Standard decisions take 72 hours;

Myths vs. Facts: Getting Poteligeo (mogamulizumab-kpkc) Covered by Cigna in New Jersey

Answer Box: Getting Poteligeo (mogamulizumab-kpkc) Covered by Cigna in New Jersey Cigna requires prior authorization for Poteligeo (mogamulizumab-kpkc) for relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy failure. Submit through Express Scripts/Accredo with complete TNMB staging, prior therapy documentation, and specialist oversight. If denied, file

Getting Eloctate Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Eloctate (efmoroctocog alfa) requires prior authorization from Humana in Washington. Start by having your hematologist submit a complete PA form with bleeding history, prior therapy failures, and weight-based dosing calculations through Humana's provider portal. If denied, you have 65 days to appeal internally, then can request

How to Get Eylea or Lucentis Covered by Cigna in Illinois: Appeals Guide with Forms and Timelines

Quick Answer: Getting Eylea or Lucentis Approved by Cigna in Illinois Cigna requires prior authorization for Eylea (aflibercept) and Lucentis (ranibizumab) with step therapy requiring bevacizumab trial first. Submit PA requests through CoverMyMeds or call 1-800-882-4462. If denied, you have 180 days to appeal internally, then 4 months for Illinois

How to Get Tavalisse (fostamatinib) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide

Answer Box: Fast Track to Tavalisse Coverage Aetna CVS Health requires prior authorization for Tavalisse (fostamatinib) in New Jersey, with initial approval typically granted for 12 weeks when medical necessity criteria are met. The fastest path: have your hematologist submit a complete PA request through Availity with documented failure of

How to Get Xospata (Gilteritinib) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Xospata (Gilteritinib) Covered by Cigna in North Carolina Xospata requires prior authorization from Cigna for relapsed/refractory AML with confirmed FLT3 mutation. Your fastest path: 1) Verify FLT3 test results (ITD or TKD via FDA-approved assay), 2) Have your hematologist/oncologist submit PA via Cigna portal with