Topic

New Jersey

A collection of 505 issues

Renewing Acthar Gel Coverage with UnitedHealthcare in New Jersey: Complete Timeline and Documentation Guide

Answer Box: Renewing Acthar Gel with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization renewal for Acthar Gel, but all reauthorization requests are automatically denied for most conditions—continuation requires appealing to the UHC Pharmacy appeals team. Start your renewal process 2-4 weeks before your current authorization expires to avoid

The Complete Requirements Checklist to Get Revlimid (lenalidomide) Covered by Cigna in New Jersey

Answer Box: Getting Revlimid (lenalidomide) Covered by Cigna in New Jersey Fastest path to approval: Submit electronic prior authorization (PA) through CoverMyMeds or EviCore with complete REMS enrollment, diagnosis documentation (ICD-10 codes C90.0 for multiple myeloma, D46.Z for MDS, C83.1 for mantle cell lymphoma), and prior therapy

How Long Does It Take to Get Fintepla (Fenfluramine) Approved by Aetna (CVS Health) in New Jersey? Complete Timeline & Appeals Guide

Answer Box: Getting Fintepla Approved by Aetna (CVS Health) in New Jersey Standard timeline: 15-30 days for prior authorization; 72 hours for urgent cases. Aetna requires documented failure of ≥2 preferred antiseizure medications, REMS enrollment (prescriber and patient), and baseline echocardiogram for Dravet syndrome or Lennox-Gastaut syndrome patients ≥2 years

How to Get Trikafta Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Get Trikafta Covered by UnitedHealthcare in New Jersey Trikafta requires prior authorization from UnitedHealthcare through OptumRx. You'll need: confirmed cystic fibrosis diagnosis, CFTR genotype showing F508del or another responsive mutation, and prescription from a CF specialist. If denied, New Jersey's IHCAP program offers external

The Complete Guide to Getting StrataGraft Covered by Cigna in New Jersey: Prior Authorization, Appeals, and Documentation Requirements

Answer Box: Getting StrataGraft Covered by Cigna in New Jersey StrataGraft requires prior authorization from Cigna for deep partial-thickness thermal burns in adults. Submit PA via Cigna's provider portal with burn specialist notes, wound photos, measurements, and proof of failed conventional therapy. If denied, file internal appeals within

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

Answer Box: Getting Turalio Covered by Blue Cross Blue Shield in New Jersey Turalio (pexidartinib) requires prior authorization from all Blue Cross Blue Shield plans in New Jersey. Here's your fastest path to approval: 1. Enroll in TURALIO REMS first - both prescriber and patient must complete enrollment

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Humana in New Jersey: Renewal Guide with Appeals Process

Answer Box: Getting Tafamidis Renewal Approved by Humana in New Jersey Eligibility: Humana Medicare Advantage/Part D members in New Jersey need annual prior authorization renewal for tafamidis (Vyndaqel/Vyndamax) with confirmed ATTR-CM diagnosis and cardiology oversight. Fastest path: Submit renewal PA 30-45 days before expiration via Humana provider portal

How to Get Rebif (interferon beta-1a) Covered by Humana in New Jersey: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Rebif (interferon beta-1a) Covered by Humana in New Jersey Fastest path to approval: Check your Humana plan's formulary status using their Prior Authorization Search Tool, then have your neurologist submit a detailed medical necessity letter with your prior authorization request. If denied, you have 65

How to Get HyperHEP B Covered by Cigna in New Jersey: Prior Authorization Guide and Appeals Process

Answer Box: Quick Path to Coverage To get HyperHEP B covered by Cigna in New Jersey: Submit prior authorization through Cigna's provider portal with exposure documentation, immunity testing, and CDC timeline compliance (within 24 hours for needlestick, 14 days for sexual exposure). If denied, file internal appeal within

How to Get Zolgensma (onasemnogene abeparvovec-xioi) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in New Jersey Zolgensma (onasemnogene abeparvovec-xioi) requires prior authorization from Humana Medicare Advantage plans in New Jersey as a high-cost specialty gene therapy (HCPCS J3399). Coverage requires genetic confirmation of SMA with SMN1 mutation, age under 2 years, negative AAV9 antibody titers, and