Topic

New Jersey

A collection of 505 issues

How to Get Kalydeco (ivacaftor) Covered by Cigna in New Jersey: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Kalydeco Covered by Cigna in New Jersey Kalydeco (ivacaftor) requires prior authorization from Cigna via Express Scripts for cystic fibrosis patients with documented CFTR responsive mutations. Submit genetic test results proving responsive mutations (G551D, R117H, etc.) plus CF specialist's medical necessity letter through CoverMyMeds or

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

Answer Box: Getting Joenja Approved by BCBS in New Jersey Blue Cross Blue Shield plans in New Jersey typically require prior authorization for Joenja (leniolisib) with specific APDS diagnostic criteria. The fastest path involves: (1) confirming genetic APDS diagnosis with molecular testing, (2) submitting PA through your specialist with imaging

How to Get Elelyso (Taliglucerase Alfa) Covered by UnitedHealthcare in New Jersey: Complete Appeal Guide

Answer Box: Getting Elelyso Covered by UnitedHealthcare in New Jersey Elelyso (taliglucerase alfa) requires prior authorization from UnitedHealthcare and may not be on formulary, but you have strong appeal rights in New Jersey. Start with a peer-to-peer review within 24 hours of denial, then file a formal appeal through the

Get StrataGraft Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization Guide with Forms and Appeals Process

Answer Box: Getting StrataGraft Covered by Aetna CVS Health in New Jersey StrataGraft requires prior authorization from Aetna CVS Health in New Jersey for adults 18+ with deep partial-thickness thermal burns requiring surgical intervention. Submit via the Aetna provider portal using HCPCS code J7353 with burn surgeon documentation. If denied,

How to Get Vigabatrin (Sabril) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vigabatrin Covered by Humana in New Jersey Humana requires prior authorization for vigabatrin (generic or brand Sabril) in New Jersey for FDA-approved uses: infantile spasms (ages 1 month-2 years) or refractory complex partial seizures (≥2 years). Key requirements include failed trials of 2-4 other antiseizure medications, REMS

Blue Cross Blue Shield New Jersey Coverage for Hetlioz LQ (Tasimelteon): Complete PA Guide and Appeals Process

Answer Box: Getting Hetlioz LQ Covered in New Jersey Blue Cross Blue Shield of New Jersey requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) for Smith-Magenis syndrome patients ages 3-15, with documented melatonin failure for 6+ months. Submit through your sleep specialist via Horizon's provider portal with

Get Takhzyro (lanadelumab-flyo) Covered by Humana in New Jersey: PA Forms, Appeals & IHCAP Guide

Answer Box: Getting Takhzyro (lanadelumab-flyo) Covered by Humana in New Jersey Takhzyro requires prior authorization from Humana and is typically covered as a Tier 4 specialty drug through CenterWell Specialty Pharmacy. Your fastest path: 1) Have your HAE specialist submit a PA request via Humana's provider portal with

Work With Your Doctor to Get Tracleer (bosentan) Covered by Humana in New Jersey: Complete Prior Authorization Guide

Quick Answer: Getting Tracleer (bosentan) Approved by Humana in New Jersey Humana requires prior authorization for Tracleer (bosentan) with strict REMS enrollment and WHO Group 1 PAH criteria. Your doctor must submit PA documentation including right heart catheterization results, REMS compliance, and monthly monitoring plans. If denied, you have 65

How to Renew Ocrevus (Ocrelizumab) Approval with Humana in New Jersey: 2025 Renewal Requirements and Timeline

Answer Box: Renewing Ocrevus (Ocrelizumab) with Humana in New Jersey Humana requires prior authorization renewal for Ocrevus (ocrelizumab) every 6-12 months, with no grace period for continuation coverage. Start your renewal 30-45 days before your current authorization expires to avoid treatment gaps. Submit updated medical necessity documentation through your provider&

How Long Does It Take to Get Sumavel DosePro Covered by Blue Cross Blue Shield in New Jersey? Complete Timeline & Approval Guide

Quick Answer: Sumavel DosePro (needle-free sumatriptan injection) is discontinued in the U.S., but generic sumatriptan auto-injectors follow similar approval pathways with Blue Cross Blue Shield in New Jersey. Expect 5-7 business days for routine prior authorization after completing step therapy with oral triptans. Start by checking your formulary status,