Topic

New Jersey

A collection of 409 issues

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
6 min read

How to Get Alprolix Covered by UnitedHealthcare in New Jersey: PA Forms, Appeals, and State Resources

Answer Box: Getting Alprolix Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization (PA) for Alprolix through OptumRx, with coverage contingent on confirmed hemophilia B diagnosis, hematologist prescription, and documented failure of standard half-life factor IX therapy (≥50 exposure days). Submit PA via the UnitedHealthcare Provider Portal with medical
6 min read

Humana's Coverage Criteria for Hemlibra (emicizumab-kxwh) in New Jersey: What Counts as "Medically Necessary"?

Answer Box: Getting Hemlibra Covered by Humana in New Jersey Hemlibra (emicizumab-kxwh) requires prior authorization from Humana Medicare plans with specific medical necessity criteria: confirmed hemophilia A diagnosis (ICD-10 D66), documented factor VIII inhibitor status (≥5 Bethesda units), bleeding history, and weight-based dosing plan. Submit through Humana's provider
6 min read

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Tepezza Coverage with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) in New Jersey for moderate-to-severe thyroid eye disease. Your ophthalmologist or endocrinologist must submit documentation showing Clinical Activity Score ≥3, euthyroid status, and failed corticosteroid treatment via the UHC Provider Portal. If denied, New
6 min read

Myths vs. Facts: Getting Poteligeo (mogamulizumab-kpkc) Covered by Cigna in New Jersey

Answer Box: Getting Poteligeo (mogamulizumab-kpkc) Covered by Cigna in New Jersey Cigna requires prior authorization for Poteligeo (mogamulizumab-kpkc) for relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy failure. Submit through Express Scripts/Accredo with complete TNMB staging, prior therapy documentation, and specialist oversight. If denied, file
5 min read

Renewing Orfadin (nitisinone) Approval with Aetna (CVS Health) in New Jersey: Timeline, Documentation & Appeal Process

Answer Box: Key Steps for Orfadin Renewal Success Orfadin (nitisinone) is excluded from Aetna's 2025 specialty formulary, requiring a formulary exception for any coverage. Start renewal 60-90 days early with updated labs (succinylacetone, tyrosine levels, liver function tests), metabolic specialist notes documenting treatment response, and dietary compliance records.
6 min read