Topic

New Jersey

A collection of 505 issues

The Complete Requirements Checklist to Get Jakafi (ruxolitinib) Covered by UnitedHealthcare in New Jersey: Forms, Appeals, and Timeline

Answer Box: Getting Jakafi Covered in New Jersey UnitedHealthcare requires prior authorization for Jakafi (ruxolitinib) through OptumRx with specific clinical criteria for myelofibrosis, polycythemia vera, and GVHD. In New Jersey, if denied, you have 180 days for internal appeals, then external review through Maximus (IHCAP). First step today: Gather your
4 min read

Complete Requirements Checklist to Get Mavenclad (Cladribine Tablets) Covered by UnitedHealthcare in New Jersey: Forms, Timelines, and Appeal Process

Answer Box: Getting Mavenclad Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Mavenclad (cladribine tablets) through OptumRx, with step therapy requiring documented failure of at least one other MS disease-modifying therapy. Submit electronically via the UnitedHealthcare Provider Portal with complete clinical documentation for 24-72 hour processing. If
6 min read

How to Get Strensiq (Asfotase Alfa) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization Guide with Appeals

Quick Answer: UnitedHealthcare covers Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia through OptumRx with prior authorization. Submit PA documentation including diagnosis confirmation, low alkaline phosphatase levels, and specialist prescription. If denied, you have 60 days for internal appeals and 4 months for New Jersey's external review through Maximus Federal
6 min read

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