Topic

New Jersey

A collection of 46 issues

Getting Entresto (Sacubitril/Valsartan) Covered by UnitedHealthcare in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: UnitedHealthcare requires prior authorization for Entresto in New Jersey with specific criteria: heart failure diagnosis, LVEF ≤40% or structural heart disease, NYHA Class II-IV, cardiologist prescription, and discontinuation of ACE inhibitors/ARBs. Submit through the UnitedHealthcare provider portal or fax to 1-866-434-5523. If denied, you have 180 days

Getting Venclexta (venetoclax) Covered by Humana in New Jersey: Prior Authorization, Appeals, and Medical Necessity Guide

Answer Box: Fast Track to Venclexta Coverage To get Venclexta (venetoclax) covered by Humana in New Jersey: Your doctor must submit prior authorization with clinical documentation showing medical necessity, including diagnosis (CLL/AML), tumor lysis syndrome monitoring plan, and justification for why formulary alternatives won't work. Submit via

Getting Mepsevii (Vestronidase Alfa) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval To get Mepsevii (vestronidase alfa-vjbk) covered by UnitedHealthcare in New Jersey: Submit prior authorization through OptumRx with complete MPS VII diagnostic proof (enzyme assay, genetic testing, elevated uGAGs) from a metabolic specialist. If denied, file internal appeal within 180 days, then external review through

Work With Your Doctor to Get Procysbi Covered by Blue Cross Blue Shield in New Jersey: Complete Provider Collaboration Guide

Quick Answer: Your Path to Procysbi Coverage Getting Procysbi (cysteamine bitartrate DR) covered by Blue Cross Blue Shield in New Jersey requires close collaboration with your doctor. Most BCBS plans require prior authorization and often mandate step therapy with immediate-release cysteamine first. Your fastest path: (1) Schedule a focused appointment

How Long Does It Take to Get Oxlumo (Lumasiran) Approved by Cigna in New Jersey? Complete Timeline Guide

Answer Box: Getting Oxlumo (Lumasiran) Approved by Cigna in New Jersey Timeline: Cigna typically reviews Oxlumo (lumasiran) prior authorization requests within 1-3 business days through Express Scripts. First step: Have your nephrologist or urologist submit genetic confirmation of PH1 (AGXT gene mutations), baseline urinary oxalate levels, and clinical documentation. If

Renewing Gattex (Teduglutide) Approval with Cigna in New Jersey: Complete Guide to Documentation and Deadlines

Quick Answer: Cigna requires specific renewal documentation for Gattex (teduglutide) including proof of reduced parenteral nutrition needs, lab results from the past 6 months (bilirubin, alkaline phosphatase, lipase, amylase), and colonoscopy documentation if you've been on therapy for over a year. Contact Accredo specialty pharmacy 2 weeks before

How to Get Daybue (Trofinetide) Covered by Cigna in New Jersey: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Daybue Covered by Cigna in New Jersey Daybue (trofinetide) requires prior authorization from Cigna with specific documentation for Rett syndrome patients ≥2 years old. Your fastest path to approval: (1) Have your neurologist submit PA with confirmed MECP2 genetic testing and Clinical Severity Scale scores, (2) coordinate

How to Get Tavalisse (fostamatinib) Covered by UnitedHealthcare in New Jersey: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Tavalisse Covered by UnitedHealthcare in New Jersey Fastest Path to Approval: UnitedHealthcare requires prior authorization for Tavalisse (fostamatinib) with step therapy documentation. You'll need proof of failed corticosteroids and typically a thrombopoietin receptor agonist, plus platelet counts <30,000/μL documented by a hematologist.

How Long Does It Take to Get Rylaze Approved by UnitedHealthcare in New Jersey? Complete Timeline Guide

Answer Box: Getting Rylaze Approved by UnitedHealthcare in New Jersey Fastest approval path: Submit prior authorization with complete hypersensitivity documentation to E. coli asparaginase within 24-72 hours. UnitedHealthcare requires oncologist prescription, ALL/LBL diagnosis proof, and detailed allergy records. If denied, New Jersey's IHCAP external review provides binding

How to Get Soliris (Eculizumab) Covered by UnitedHealthcare in New Jersey: Complete Guide to Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Soliris Covered in New Jersey Eligibility: UnitedHealthcare requires prior authorization for Soliris (eculizumab) with strict documentation of approved conditions (PNH, aHUS, gMG, NMOSD), meningococcal vaccination records, and REMS compliance. Fastest path: Submit PA through UnitedHealthcare provider portal with complete vaccination records and specialist prescription. First step today: