Topic

New Jersey

A collection of 505 issues

How to Get Elelyso (Taliglucerase Alfa) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Elelyso (Taliglucerase Alfa) Covered by Cigna in New Jersey Elelyso (taliglucerase alfa) requires prior authorization from Cigna and is typically covered as a Tier 5 specialty drug for confirmed Type 1 Gaucher disease. Submit the Cerezyme/Elelyso/VPRIV Prior Authorization Form via CoverMyMeds with complete diagnostic documentation.

How to Get Ultomiris (ravulizumab) Covered by UnitedHealthcare in New Jersey: Coding, Appeals, and Step Therapy Exceptions

Answer Box: Getting Ultomiris Covered by UnitedHealthcare in New Jersey Ultomiris (ravulizumab) requires prior authorization from UnitedHealthcare in New Jersey, with step therapy typically requiring eculizumab (Soliris) or biosimilars first. To get approval: 1) Submit PA with proper ICD-10 codes (D59.5 for PNH, D59.3 series for aHUS), HCPCS

How to Get Emflaza (Deflazacort) Covered by Cigna in New Jersey: Complete Guide with Appeals Process and State Protections

Answer Box: Getting Emflaza (Deflazacort) Covered by Cigna in New Jersey Eligibility: Patients with confirmed Duchenne muscular dystrophy (DMD) aged 2+ under specialist care can get Emflaza covered by Cigna, typically after trying prednisone/prednisolone first. Fastest path: Submit prior authorization via CoverMyMeds or Cigna's provider portal with

How to Get Keppra (Levetiracetam) Covered by Blue Cross Blue Shield in New Jersey: Prior Authorization Guide and Appeal Strategies

Answer Box: Quick Path to Coverage To get Keppra (levetiracetam) covered by Blue Cross Blue Shield in New Jersey: Most plans prefer generic levetiracetam (usually Tier 1-2, no PA required). For brand Keppra, expect prior authorization requiring documented failure/intolerance to generic plus clinical justification. Submit PA via provider portal

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

Answer Box: Quick Path to Bavencio (avelumab) Approval in New Jersey Cigna requires prior authorization for Bavencio (avelumab) in 2024. To get approved: (1) Submit Cigna's dedicated Bavencio PA form with complete staging, prior platinum therapy documentation (for urothelial cancer), and NCCN guideline support; (2) If denied, file

Myths vs. Facts: Getting Synagis (Palivizumab) Covered by Aetna (CVS Health) in New Jersey

Answer Box: Fast Track to Synagis Approval in New Jersey Synagis (palivizumab) requires prior authorization from Aetna (CVS Health) with step therapy mandating Beyfortus (nirsevimab) first-line unless contraindicated. High-risk infants (<29 weeks gestation, chronic lung disease, or hemodynamically significant congenital heart disease) need specialist documentation and proof Beyfortus is

Get Cabometyx (Cabozantinib) Covered by UnitedHealthcare in New Jersey: Complete PA Guide, Appeals, and IHCAP Process

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization (PA) for Cabometyx (cabozantinib) through OptumRx for all cancer indications. Fastest path: Have your oncologist submit PA via the UnitedHealthcare Provider Portal with diagnosis confirmation, prior therapy details, and RECIST imaging. If denied, New Jersey residents

Coding That Helps Get Naglazyme (Galsulfase) Approved by Blue Cross Blue Shield in New Jersey: ICD-10, HCPCS J-Code, and NDC Guide

Answer Box: Getting Naglazyme Covered in New Jersey Naglazyme (galsulfase) requires prior authorization from Blue Cross Blue Shield in New Jersey and is covered under medical benefits using HCPCS J1458. Key coding requirements: ICD-10 E76.29 (MPS VI), J1458 (1 unit = 1 mg), weight-based dosing (1 mg/kg weekly), and

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

Answer Box: Getting Venclexta Covered in New Jersey Horizon Blue Cross Blue Shield of New Jersey requires prior authorization (PA) for Venclexta (venetoclax), covering it as a Tier 5 specialty drug for FDA-approved CLL/SLL and AML indications. To get approved: 1. Verify coverage via Horizon's formulary and

Renewing Isturisa (Osilodrostat) Approval with Cigna in New Jersey: 2025 Guide to Timelines, Documentation & Appeals

Answer Box: Renewing Isturisa (Osilodrostat) with Cigna in New Jersey Cigna requires prior authorization renewal for Isturisa (osilodrostat) annually or through plan year-end, prescribed by an endocrinologist with documented treatment response. Submit renewal 30-60 days before expiration via EviCore portal with updated cortisol labs, clinical response documentation, and prescriber attestation.