Counterforce Health (Page 20)

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How to Get Nucala (Mepolizumab) Covered by Cigna in New Jersey: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Cigna Coverage for Nucala in New Jersey Cigna requires prior authorization for Nucala (mepolizumab) with specific clinical criteria including blood eosinophil levels ≥300 cells/μL within 6 weeks and documented failure of high-dose inhaled corticosteroids plus LABA therapy. Submit requests via CoverMyMeds or Cigna's provider

How to Get Luxturna (voretigene neparvovec-rzyl) Covered by Humana in Washington: Forms, Appeals, and Resources

Answer Box: Getting Luxturna Covered by Humana in Washington Luxturna requires prior authorization (PA) from Humana Medicare Advantage plans in 2024-2025. To get approved in Washington: 1) Submit the "Request for Medicare Prescription Drug Coverage Determination" form via CoverMyMeds portal or fax to 877-486-2621, 2) Include confirmed biallelic

How to Get Arikayce Covered by Blue Cross Blue Shield in New York: Prior Authorization Forms, Appeal Scripts, and External Review

Quick Answer: Getting Arikayce Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield of New York requires prior authorization for Arikayce (amikacin liposome inhalation) for refractory MAC lung disease. Submit PA via Availity Essentials with proof of 6+ months failed combination therapy and positive sputum cultures.

How to Get Koselugo (Selumetinib) Covered by Cigna in New York: Complete Guide with Forms, Appeals, and Timelines

Answer Box: Getting Koselugo (Selumetinib) Covered by Cigna in New York Cigna requires prior authorization for Koselugo (selumetinib) in pediatric patients ≥2 years with NF1-related plexiform neurofibromas. Initial approval lasts 12 months with documented baseline LVEF and ophthalmologic evaluation. First step: Have your oncologist submit PA through Cigna's

How to Get Revlimid (Lenalidomide) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Revlimid Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield of Virginia requires prior authorization for Revlimid (lenalidomide), with approval depending on FDA-approved indications like multiple myeloma, documented prior treatment failures, and enrollment in the mandatory Lenalidomide REMS program. Your oncologist must submit clinical

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Aetna CVS Health in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Besponsa Covered by Aetna CVS Health in Washington Aetna CVS Health requires prior authorization for Besponsa (inotuzumab ozogamicin) in Washington. Coverage is approved for CD22-positive B-cell precursor ALL (relapsed/refractory) with documented prior therapy failures. Fastest path: Your oncologist submits the Aetna Besponsa precertification form with CD22+

Ruconest (C1 Esterase Inhibitor) Approval with Aetna CVS Health in Michigan: Complete Prior Authorization Guide

Quick Answer: Getting Ruconest Covered by Aetna CVS Health in Michigan Yes, Aetna CVS Health covers Ruconest (C1 esterase inhibitor, recombinant) for acute hereditary angioedema (HAE) attacks in Michigan, but requires prior authorization. The fastest path: 1) Have your HAE specialist complete Aetna's Ruconest Precertification Request form, 2)

How to Get Trikafta Approved by Blue Cross Blue Shield in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by BCBS Georgia Trikafta requires prior authorization from Blue Cross Blue Shield of Georgia (Anthem). To get approved: (1) Have your CF specialist submit a PA through Anthem's provider portal with genetic testing showing F508del or eligible CFTR mutations, (2) Include diagnosis (ICD-10

How to Get Stelara (Ustekinumab) Covered by UnitedHealthcare in Washington: Complete Guide to Prior Authorization, Appeals, and Medical Necessity Letters

Answer Box: Your Path to Stelara Coverage in Washington UnitedHealthcare requires prior authorization for brand Stelara (ustekinumab) with step therapy through biosimilars first. In Washington, if denied, you have 180 days for internal appeals plus external review through an Independent Review Organization. Start today: Have your doctor submit a medical

How to Get Tegsedi (Inotersen) Covered by Cigna in Georgia: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Tegsedi (inotersen) covered by Cigna in Georgia, you need: (1) genetic confirmation of hATTR polyneuropathy, (2) REMS enrollment for prescriber and patient, (3) prior authorization with baseline labs and monitoring plan, and (4) specialty pharmacy routing through Accredo. If denied, Georgia law gives you 60 days