Topic

New Jersey

A collection of 505 issues

How to Get Cosentyx (Secukinumab) Covered by Blue Cross Blue Shield in New Jersey: 2025 PA Rules, Appeals, and Step Therapy Overrides

Answer Box: Your Fastest Path to Cosentyx Coverage Getting Cosentyx (secukinumab) approved by Blue Cross Blue Shield in New Jersey requires prior authorization, but New Jersey's 2026 step therapy reform (A1825) strengthens your rights. Submit your PA request through Horizon BCBS's provider portal, documenting inadequate response

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

How to Get Tavalisse (fostamatinib) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide

Answer Box: Fast Track to Tavalisse Coverage Aetna CVS Health requires prior authorization for Tavalisse (fostamatinib) in New Jersey, with initial approval typically granted for 12 weeks when medical necessity criteria are met. The fastest path: have your hematologist submit a complete PA request through Availity with documented failure of

Myths vs. Facts: Getting Tepezza (teprotumumab) Covered by Humana in New Jersey

Answer Box: Tepezza Coverage Facts for New Jersey Humana Members Myth-busting reality: Tepezza (teprotumumab) requires prior authorization through Humana Medicare Advantage in New Jersey, but approval is possible with proper documentation. Key facts: Submit PA via Humana Clinical Pharmacy Review (800-555-2546), include Clinical Activity Score ≥4, thyroid labs ≤30 days,

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.

How to Get Kymriah Covered by Blue Cross Blue Shield in New Jersey: Complete PA Guide with Forms and Appeal Scripts

Quick Start: Get Kymriah Covered by Blue Cross Blue Shield in New Jersey Getting Kymriah (tisagenlecleucel) covered by Horizon Blue Cross Blue Shield of New Jersey requires prior authorization through their medical policy CC-06005. Your oncologist must document CD19-positive B-cell ALL or eligible lymphoma, failed prior therapies, and treatment at

How to Get Nucala (Mepolizumab) Covered by Cigna in New Jersey: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Cigna Coverage for Nucala in New Jersey Cigna requires prior authorization for Nucala (mepolizumab) with specific clinical criteria including blood eosinophil levels ≥300 cells/μL within 6 weeks and documented failure of high-dose inhaled corticosteroids plus LABA therapy. Submit requests via CoverMyMeds or Cigna's provider

How to Get Hemlibra (Emicizumab) Covered by Blue Cross Blue Shield in New Jersey: Complete PA Guide with Appeals Timeline

Answer Box: Getting Hemlibra Covered in New Jersey Horizon Blue Cross Blue Shield of New Jersey covers Hemlibra (emicizumab) as a specialty medication requiring prior authorization through its Medical Injectables Program. First step: Have your hematologist submit a Medical Necessity and Appropriateness Review (MNAR) including hemophilia A diagnosis, inhibitor status,

Work With Your Doctor to Get Synagis (Palivizumab) Approved by UnitedHealthcare in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Synagis Covered in New Jersey UnitedHealthcare requires prior authorization for Synagis (palivizumab) in high-risk pediatric patients under 24 months, with coverage limited to 5 monthly doses per RSV season. Your pediatrician must document specific criteria: prematurity (<29 weeks if under 12 months), chronic lung disease requiring

Work With Your Doctor to Get Dupixent (dupilumab) Approved by Humana in New Jersey: Complete Provider Partnership Guide

Answer Box: Getting Dupixent Covered by Humana in New Jersey Dupixent (dupilumab) requires prior authorization from Humana Medicare Advantage and Part D plans, with specific step therapy and medical necessity documentation. Your doctor must submit a PA form showing failed trials of topical treatments (atopic dermatitis) or inhaled medications (asthma)