Counterforce Health (Page 34)

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How to Get Hemgenix (etranacogene dezaparvovec) Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hemgenix Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Hemgenix (etranacogene dezaparvovec) with strict eligibility criteria including age 18+, severe/moderately severe hemophilia B, 50+ factor IX exposure days, and treatment at a hemophilia center. If denied, Pennsylvania's Independent External Review Program offers

Getting Thiola / Thiola EC (tiopronin) Covered by Aetna in California: Complete PA Guide & Appeal Process

Answer Box: Getting Thiola / Thiola EC Covered by Aetna in California Aetna requires prior authorization for Thiola/Thiola EC (tiopronin) with 12-month initial approval based on confirmed cystinuria diagnosis, failed conservative therapy, and elevated 24-hour urine cystine levels (≥300 mg/day). Submit via prescriber through Availity portal with genetic testing,

Work With Your Doctor to Get Tavalisse (Fostamatinib) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Prior Authorization Guide

Quick Answer: Getting Tavalisse Covered in Pennsylvania To get Tavalisse (fostamatinib) covered by Blue Cross Blue Shield in Pennsylvania, you'll need prior authorization from a hematologist or oncologist documenting chronic ITP diagnosis, platelet count below 30,000/μL, and failure of first-line therapies (corticosteroids, IVIG, or TPO agonists)

Lowering Out-of-Pocket for Signifor / Signifor LAR (pasireotide) with UnitedHealthcare in New Jersey: Copay, Tiering & Assistance

Quick Answer: Reducing Your Signifor LAR Costs with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Signifor LAR (pasireotide) with potential high specialty tier costs. Key cost-reduction strategies include the manufacturer's $20 copay program for commercial insurance, foundation grants up to $13,600/year, and formulary tier

How to Get Gilenya (Fingolimod) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Guide and Appeals Process

Answer Box: Getting Gilenya Covered in Washington Gilenya (fingolimod) requires prior authorization from Blue Cross Blue Shield plans in Washington. To get approved, you'll need baseline testing (EKG, eye exam, labs), documentation of MS diagnosis, and often proof that you've tried other therapies first. If denied,

How to Get Signifor / Signifor LAR (pasireotide) Covered by Cigna in Illinois: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Signifor/Signifor LAR Covered by Cigna in Illinois Cigna requires prior authorization for all Signifor/Signifor LAR (pasireotide) prescriptions in Illinois. For acromegaly, you must first try octreotide or lanreotide; for Cushing's disease, document surgical failure or ineligibility. Your endocrinologist must submit detailed clinical evidence

Coding That Helps Get Elelyso (Taliglucerase Alfa) Approved in Washington with UnitedHealthcare: ICD-10, HCPCS J-Code, and Billing Guide

Answer Box: Fast Track to Elelyso Coverage Getting Elelyso (taliglucerase alfa) covered by UnitedHealthcare in Washington requires precise coding and documentation. Use ICD-10 code E75.22 for Gaucher disease, HCPCS J-code J3060 for billing (10 units per code), and calculate total dose ÷ 10 for billable units. Submit prior authorization through

How to Get Rebif (Interferon Beta-1a) Covered by Cigna in Washington: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Rebif Covered by Cigna in Washington Rebif (interferon beta-1a) requires prior authorization from Cigna, typically managed through Express Scripts/Accredo specialty pharmacy. The fastest path to approval: 1) Ensure your neurologist documents relapsing MS with proper ICD-10 codes (G35.A for RRMS, G35.C1 for active SPMS)

How to Get Aldurazyme (laronidase) Covered by Blue Cross Blue Shield in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Aldurazyme Coverage in California Blue Shield of California covers Aldurazyme (laronidase) as a specialty drug requiring prior authorization for MPS I patients. The fastest path to approval: (1) Gather genetic/enzymatic confirmation of MPS I diagnosis, (2) Document baseline disease severity and prior treatment failures, (3) Submit

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

Answer Box: Getting Opsumit (Macitentan) Covered by Cigna in Texas Fastest path to approval: Have your PAH specialist submit a prior authorization request through Cigna's provider portal with documentation of your PAH diagnosis, functional class, prior therapy failures, and REMS enrollment. Timeline: 72 hours for standard review, 24