Counterforce Health (Page 12)

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How to Get Nucala (Mepolizumab) Covered by Blue Cross Blue Shield in Pennsylvania: 2024 Appeals Guide

Answer Box: Getting Nucala Covered in Pennsylvania To get Nucala (mepolizumab) covered by Blue Cross Blue Shield in Pennsylvania: Your doctor must submit a prior authorization request with blood eosinophil count ≥150 cells/µL, proof of severe eosinophilic asthma uncontrolled on high-dose ICS/LABA therapy, and exacerbation history. If denied,

How to Get Retevmo (selpercatinib) Covered by Cigna in Ohio: Complete Prior Authorization and Appeal Guide

Answer Box: Fastest Path to Retevmo Coverage Cigna requires prior authorization for Retevmo (selpercatinib) in Ohio. Your oncologist must submit documentation proving RET gene alteration via FDA-approved testing (like FoundationOne CDx), diagnosis of RET fusion-positive NSCLC or RET-mutant thyroid cancer, and prior treatment history. Submit through Cigna's provider

How to Get Eloctate Covered by Aetna CVS Health in California: Prior Authorization, Appeals, and State Protection Rights

Answer Box: Getting Eloctate Covered by Aetna CVS Health in California Eloctate requires prior authorization from Aetna CVS Health and must be prescribed by a hematologist. The fastest path to approval: (1) Have your hematologist gather comprehensive clinical documentation including bleeding history and prior treatment failures, (2) Submit the PA

UnitedHealthcare's Coverage Criteria for HyperHEP in New Jersey: What Counts as "Medically Necessary"?

Answer Box: Getting HyperHEP Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for HyperHEP (hepatitis B immune globulin) based on documented exposure and timing. Medical necessity requires: (1) exposure to HBsAg-positive blood/fluids within 7 days, (2) patient susceptibility (unvaccinated or non-immune), and (3) proper dosing (0.06

How to Get Skyrizi (Risankizumab) Covered by Humana in New Jersey: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Skyrizi Covered by Humana in New Jersey Skyrizi (risankizumab) is covered by Humana Medicare Advantage plans in New Jersey as a Tier 5 specialty drug requiring prior authorization. The fastest path to approval: 1) Have your doctor submit a complete PA request with diagnosis documentation, prior TNF

Denied for Ilaris (Canakinumab) by Cigna in Illinois? Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Ilaris (Canakinumab) Approved by Cigna in Illinois If Cigna denied your Ilaris (canakinumab) prior authorization, you have strong appeal rights in Illinois. Most denials can be overturned with proper documentation. Here's your fastest path to approval: 1. Request peer-to-peer review with Cigna's medical

How to Get Isturisa (Osilodrostat) Covered by Cigna in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Isturisa Covered by Cigna in Texas Cigna requires prior authorization for Isturisa (osilodrostat) with specific clinical documentation. The fastest path to approval requires: (1) endocrinologist prescription with confirmed Cushing's disease diagnosis, (2) documented surgical contraindication or failure, and (3) abnormal cortisol test results (UFC, salivary

Getting Revcovi (Elapegademase) Covered by Humana in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Revcovi Coverage with Humana in Texas Getting Revcovi (elapegademase) covered by Humana requires prior authorization with documented ADA-SCID diagnosis and specialist oversight. Submit through Humana's provider portal with ADA enzyme testing (<1% normal activity) or genetic confirmation, plus a medical necessity letter

How to Get Isturisa (Osilodrostat) Covered by UnitedHealthcare in California: Complete Prior Authorization Guide

Answer Box: Getting Isturisa Covered by UnitedHealthcare in California Isturisa (osilodrostat) requires prior authorization from UnitedHealthcare but has no step therapy requirement when clinical criteria are met. Key requirements: confirmed Cushing's syndrome diagnosis, surgery ineligibility/failure documentation, and endocrinologist prescriber. Submit through UnitedHealthcare's electronic portal with

How to Get Filsuvez (Birch Triterpenes Gel) Covered by Aetna CVS Health in Washington: Appeals, Alternatives & Prior Authorization

Answer Box: Getting Filsuvez Covered by Aetna CVS Health in Washington Filsuvez (birch triterpenes gel) typically requires prior authorization from Aetna CVS Health and is often denied initially as non-formulary. Your fastest path: 1) Try formulary alternatives first with documented outcomes, 2) Submit a comprehensive prior authorization request with EB