Counterforce Health (Page 38)

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Renewing Vimizim (Elosulfase Alfa) Approval with Blue Cross Blue Shield of Texas: 2025 Requirements & Timeline

Answer Box: Vimizim Renewal with Blue Cross Blue Shield of Texas Good news for HealthSelect members: As of September 2024, Blue Cross Blue Shield of Texas HealthSelect plans no longer require prior authorization for Vimizim (elosulfase alfa) renewals. However, you still need an in-network PCP referral on file. For other

UnitedHealthcare's Coverage Criteria for Gattex (Teduglutide) in Pennsylvania: What Counts as "Medically Necessary"?

Answer Box: Getting Gattex Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Gattex (teduglutide) with strict medical necessity criteria: documented short bowel syndrome, 12+ months of parenteral nutrition dependence (≥3 days/week), failed enteral optimization attempts, and recent colonoscopy with polyp removal. Fastest path to approval: Submit complete

How Long Does It Take to Get Arcalyst (Rilonacept) Approved by UnitedHealthcare in Ohio? Complete Timeline Guide

Answer Box: Arcalyst Approval Timeline in Ohio UnitedHealthcare typically takes 5-15 business days to approve Arcalyst (rilonacept) after complete documentation is submitted. For recurrent pericarditis, you must first document failure of NSAIDs and colchicine. Expedited reviews are available within 72 hours for urgent cases. If denied, Ohio residents have 180

How to Get Elelyso (taliglucerase alfa) Covered by Aetna CVS Health in Virginia: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Elelyso Covered by Aetna CVS Health in Virginia Elelyso (taliglucerase alfa) requires prior authorization from Aetna CVS Health in Virginia and is typically not on standard formularies. Here's your fastest path to approval: 1. Confirm diagnosis with enzyme deficiency or genetic testing results 2. Submit

How to Get Cystadane (Betaine Anhydrous) Covered by Cigna in Washington: Appeals Guide and Templates

Quick Answer: Getting Cystadane Covered by Cigna in Washington Cigna requires prior authorization for Cystadane (betaine anhydrous) with genetic/biochemical confirmation of homocystinuria due to CBS, MTHFR, or related enzyme deficiencies. If denied, Washington residents have strong appeal rights including internal appeals (180-day window) and binding external review by an

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

Answer Box: Your Path to Xospata Coverage Cigna requires prior authorization for Xospata (gilteritinib) in Texas. To get approved: (1) Ensure you have relapsed/refractory AML with documented FLT3 mutation via FDA-approved test, (2) Have your hematologist/oncologist submit prior authorization with complete treatment history, and (3) If denied, file

How to Renew Evkeeza (Evinacumab-dgnb) Coverage with Cigna in Pennsylvania: 2025 Requirements and Timeline

Quick Answer: Cigna typically grants Evkeeza (evinacumab-dgnb) renewals for one year if you submit updated clinical documentation showing continued benefit and medical necessity. Start your renewal 60-90 days before your current authorization expires. Submit through Cigna's provider portal or Express Scripts with recent lipid panels, adherence records, and

How to Get Rapivab (Peramivir) Covered by Humana in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rapivab (Peramivir) Covered by Humana in Pennsylvania Rapivab (peramivir) requires prior authorization from Humana and is typically approved only when oral antivirals like oseltamivir (Tamiflu) can't be used due to medical contraindications. Your fastest path to approval: Have your provider submit the Humana Medicare Prescription

How to Get Orladeyo (Berotralstat) Covered by UnitedHealthcare in New Jersey: Complete Guide with Forms and Appeal Templates

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in New Jersey Orladeyo (berotralstat) requires prior authorization from UnitedHealthcare in New Jersey. To get approved: 1. Visit an HAE specialist (allergist/immunologist) who can document your hereditary angioedema diagnosis with C1-INH testing and attack frequency 2. Submit prior authorization through the UnitedHealthcare

How to Get Adynovate (Antihemophilic Factor) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Adynovate Covered by Aetna CVS Health in Illinois Adynovate requires prior authorization from Aetna CVS Health in Illinois. Submit requests through the Availity portal with complete hemophilia A documentation including Factor VIII activity levels, bleeding history, and medical necessity justification. If denied, you have 180 days to