Topic

New Jersey

A collection of 243 issues

How to Get Waylivra (Volanesorsen) Covered by Aetna CVS Health in New Jersey: Appeals Guide and Policy Details

Answer Box: Getting Waylivra Covered by Aetna CVS Health in New Jersey Waylivra (volanesorsen) is not on Aetna's standard formulary and requires a medical exception appeal, not routine prior authorization. For familial chylomicronemia syndrome (FCS), you'll need genetic confirmation, triglycerides >875 mg/dL on multiple

How to Get Sumavel DosePro Covered by Cigna in New Jersey: Complete Appeals Guide and Alternative Options

Quick Answer: Sumavel DosePro Coverage with Cigna in New Jersey Important Update: Sumavel DosePro (needle-free sumatriptan injection) was discontinued in the United States in 2018 and is no longer available on any formulary, including Cigna's. However, generic sumatriptan injection remains covered by Cigna with prior authorization. Your fastest

Getting Jynarque (Tolvaptan) Covered by Aetna CVS Health in New Jersey: Complete Guide to Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Jynarque Covered by Aetna CVS Health in New Jersey Jynarque (tolvaptan) requires prior authorization from Aetna CVS Health, with strict clinical criteria including documented rapid ADPKD progression (Mayo Class 1C-1E or eGFR decline ≥3.0 mL/min/1.73 m²/year) and mandatory REMS enrollment. First step:

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

How to Get Xywav Covered by Cigna in New Jersey: Complete Prior Authorization Guide (2025)

Quick Answer: Getting Xywav Covered by Cigna in New Jersey Xywav requires prior authorization from Cigna. Your fastest path to approval: (1) Confirm your sleep specialist is enrolled in the Xywav REMS program, (2) Submit Cigna's prior authorization form with documentation of failed stimulants and confirmed narcolepsy/idiopathic

Myths vs. Facts: Getting Turalio (pexidartinib) Covered by Humana in New Jersey - Complete 2025 Guide

Answer Box: Fast Track to Turalio Coverage Getting Turalio (pexidartinib) covered by Humana in New Jersey requires three key steps: 1) Complete REMS enrollment for both prescriber and patient through the official Turalio REMS program, 2) Submit comprehensive prior authorization with MRI imaging, surgical consultation notes, and baseline liver function

How to Get Xospata (gilteritinib) Covered by Aetna (CVS Health) in New Jersey: Prior Authorization, Appeals, and Success Strategies

Answer Box: Getting Xospata Covered in New Jersey Xospata (gilteritinib) requires prior authorization from Aetna (CVS Health) in New Jersey for FLT3-mutated relapsed/refractory AML. Submit through the Availity portal at least 2 weeks before treatment, including FLT3 mutation test results, prior therapy documentation, and medical necessity letter. If denied,

Hetlioz LQ (Tasimelteon Oral Suspension) Cigna Coverage in New Jersey: Complete Prior Authorization Guide and Appeals Process

Answer Box: Getting Hetlioz LQ (Tasimelteon Oral Suspension) Covered by Cigna in New Jersey Cigna covers Hetlioz LQ for pediatric patients (ages 3-15) with Smith-Magenis syndrome in New Jersey, but requires prior authorization with strict documentation. The fastest path to approval: 1) Confirm SMS diagnosis with genetic testing, 2) Document

How to Get Duopa Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Duopa Covered by Blue Cross Blue Shield in New Jersey Duopa requires prior authorization from Blue Cross Blue Shield in New Jersey under the medical benefit (not pharmacy). Submit through your neurologist with documented advanced Parkinson's disease, ≥2-3 hours daily "OFF" time, failed