Topic

New Jersey

A collection of 504 issues

How to Get Raxone (idebenone) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Raxone (idebenone) Covered by Cigna in New Jersey Raxone (idebenone) requires prior authorization from Cigna and faces coverage challenges as a non-FDA approved medication. Your physician must submit a formulary exception request demonstrating medical necessity for LHON treatment. If denied, New Jersey's IHCAP external review

Getting Qalsody (Tofersen) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Qalsody (Tofersen) Covered by UnitedHealthcare in New Jersey UnitedHealthcare covers Qalsody (tofersen) for adults with ALS and confirmed SOD1 mutations, requiring prior authorization through OptumRx. In New Jersey, if denied, you can appeal through UnitedHealthcare's internal process, then file for external review with New Jersey&

How to Get Uptravi (Selexipag) Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals, and Coding Requirements

Answer Box: Quick Path to Approval To get Uptravi (selexipag) covered by UnitedHealthcare in New Jersey: Submit prior authorization through the UHC Provider Portal with documented WHO Group 1 PAH diagnosis (ICD-10: I27.0 or I27.21), hemodynamic data showing mean PAP >20 mmHg, and evidence of failure/intolerance

How to Get Pyrukynd (mitapivat) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pyrukynd Covered by Blue Cross Blue Shield in New Jersey Blue Cross Blue Shield in New Jersey requires prior authorization for Pyrukynd (mitapivat), with coverage based on confirmed pyruvate kinase deficiency and documented hemolytic anemia. To get approval: (1) Have your hematologist submit genetic testing showing ≥2

How to Get Hemgenix Covered by UnitedHealthcare in New Jersey: Complete PA Guide with Appeal Scripts

Answer Box: Getting Hemgenix Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Hemgenix (etranacogene dezaparvovec) with strict eligibility criteria: age ≥18, Factor IX activity ≤2%, negative inhibitors, ≥50 exposure days, and treatment at an approved Hemophilia Treatment Center. Submit through OptumRx with complete baseline documentation. If denied,

How to Get Voydeya (danicopan) Covered by UnitedHealthcare in New Jersey: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Voydeya Covered by UnitedHealthcare in New Jersey Voydeya (danicopan) requires prior authorization from UnitedHealthcare for paroxysmal nocturnal hemoglobinuria (PNH). Key requirements: ICD-10 code D59.5, proof of extravascular hemolysis despite C5 inhibitor therapy, completed vaccinations (meningococcal, pneumococcal, Hib), and REMS enrollment. Submit via UnitedHealthcare Provider Portal with

Myths vs. Facts: Getting Humate-P Covered by Cigna in New Jersey (Appeals That Work)

Answer Box: Getting Humate-P Covered by Cigna in New Jersey Cigna requires prior authorization for Humate-P (antihemophilic factor/vWF complex) in New Jersey. For von Willebrand disease, you must document failure or contraindication to both intranasal and injectable desmopressin. For hemophilia A, approval is typically granted for one year with

How to Get Kineret (anakinra) Covered by Blue Cross Blue Shield in New Jersey: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Kineret Covered in New Jersey Kineret (anakinra) requires prior authorization from Blue Cross Blue Shield in New Jersey. For rheumatoid arthritis, you'll need to show failure of conventional DMARDs like methotrexate and TNF inhibitors. Submit through your provider's portal with medical records documenting

How to Get Uplizna (Inebilizumab) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Uplizna (Inebilizumab) Covered by Blue Cross Blue Shield in New Jersey Uplizna (inebilizumab) requires prior authorization from Blue Cross Blue Shield for AQP4-positive NMOSD or IgG4-related disease. In New Jersey, your fastest path to approval involves: (1) confirming AQP4-IgG positive test results via cell-based assay, (2) documenting

How to Get Cosentyx (secukinumab) Covered by Cigna in New Jersey: Prior Authorization, Appeals, and Formulary Alternatives

Answer Box: Getting Cosentyx (secukinumab) Covered by Cigna in New Jersey Fastest path to approval: Have your rheumatologist or dermatologist submit a prior authorization request documenting trial/failure of preferred alternatives like Tremfya (guselkumab) and meet age/specialist requirements. If denied, you have 180 days for internal appeals, then external