Counterforce Health (Page 16)

More issues

Complete Guide to Getting Prolastin-C Covered by Aetna in Pennsylvania: Prior Authorization, Appeals, and Success Strategies

Answer Box: Getting Prolastin-C Covered by Aetna in Pennsylvania Yes, Aetna requires prior authorization for Prolastin-C in Pennsylvania. Success requires documented alpha-1 antitrypsin deficiency (Pi*ZZ genotype), serum AAT levels <80 mg/dL, evidence of emphysema, and FEV1 between 25-80% of predicted. Fastest path to approval: 1. Gather genetic

How to Get Isturisa (Osilodrostat) Covered by Cigna in Ohio: Complete Cost Guide with Appeals Process

Answer Box: Getting Isturisa Covered by Cigna in Ohio Isturisa (osilodrostat) requires prior authorization through Cigna's specialty pharmacy network (Accredo) and is typically covered on Tier 4/5 with high cost-sharing. Your endocrinologist must submit documentation proving Cushing's disease diagnosis, surgical history, and medical necessity. If

Denied for Orfadin (Nitisinone) by Cigna in Washington? How to Appeal (Templates & Timelines)

Answer Box: Cigna requires prior authorization for Orfadin (nitisinone) with confirmed HT-1 diagnosis (elevated succinylacetone), genetic testing, dietary management plan, and metabolic specialist involvement. If denied, you have 180 days for internal appeals and can request external review through Washington's Independent Review Organization. First step today: Gather your

The Complete Requirements Checklist to Get Cerezyme (Imiglucerase) Covered by UnitedHealthcare in Michigan

Answer Box: Getting Cerezyme Covered by UnitedHealthcare in Michigan Fastest path to approval: Submit prior authorization through OptumRx with confirmed Type 1 Gaucher disease diagnosis (ICD-10: E75.22), evidence of VPRIV failure/intolerance (step therapy requirement), and complete medical necessity documentation. Use HCPCS code J1786 for billing. If denied, Michigan

How to Get Vyondys 53 (Golodirsen) Covered by UnitedHealthcare in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Vyondys 53 Covered by UnitedHealthcare in North Carolina Eligibility: Patients with Duchenne muscular dystrophy and confirmed exon 53-amenable mutations who remain ambulatory without assistive devices. Fastest Path: Submit prior authorization through UnitedHealthcare Provider Portal with genetic testing results, ambulatory status documentation, and complete renal monitoring plan. UnitedHealthcare

How to Get Tegsedi (Inotersen) Covered by Aetna CVS Health in California: Decision Tree, Appeals, and Next Steps

Answer Box: Getting Tegsedi Coverage in California Aetna CVS Health requires prior authorization for Tegsedi (inotersen) with strict criteria: confirmed TTR gene mutation, hATTR polyneuropathy diagnosis, specialist prescriber, and REMS enrollment. In California, if denied, you have strong appeal rights through the DMHC's Independent Medical Review (IMR) system,

Work With Your Doctor to Get Mycapssa (Octreotide, Oral) Approved by UnitedHealthcare in New York: Provider Partnership Guide

Quick Answer: Getting Mycapssa Covered in New York To get Mycapssa (octreotide, oral) approved by UnitedHealthcare in New York, you'll need to work closely with your endocrinologist to document prior response to injectable octreotide/lanreotide, submit comprehensive prior authorization with medical necessity justification, and be prepared for peer-to-peer

How to Get iLink® Corneal Cross-Linking Covered by Aetna CVS Health in Pennsylvania: Prior Authorization Guide and Appeals Process

Quick Answer: Getting iLink® Covered by Aetna CVS Health in Pennsylvania Aetna CVS Health covers FDA-approved iLink® corneal cross-linking for progressive keratoconus in Pennsylvania when you meet specific criteria. Prior authorization is required with documented disease progression, minimum 400-micron corneal thickness, and use of an in-network provider. If denied, Pennsylvania&

How to Get Opsumit (Macitentan) Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Opsumit Covered by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Opsumit (macitentan). Your doctor must submit a PA request through the BCBS provider portal or Availity, documenting your PAH diagnosis and any failed prior treatments. If denied, you have 180 days to

Denied Kalydeco (Ivacaftor) by Cigna in Georgia? Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Kalydeco Covered by Cigna in Georgia If Cigna denied your Kalydeco (ivacaftor) prescription, you have 180 days to file an internal appeal and 60 days for external review after final denial. Start today by gathering your CFTR genetic test results, CF specialist's clinical notes, and