Topic

New Jersey

A collection of 505 issues

Myths vs. Facts: Getting Imbruvica (ibrutinib) Covered by Humana in New Jersey

Answer Box Getting Imbruvica (ibrutinib) covered by Humana in New Jersey requires prior authorization and often step therapy with preferred BTK inhibitors first. Most plans place Imbruvica as non-preferred (Tier 4) while favoring acalabrutinib or zanubrutinib. If denied, appeal internally within 65 days, then escalate to New Jersey's

How to Get Gilenya (Fingolimod) Covered by Humana in New Jersey: Complete Renewal Guide with Appeal Scripts

Answer Box: Getting Gilenya (Fingolimod) Covered by Humana in New Jersey Fastest path to approval: Submit prior authorization through Humana's provider portal with complete medical necessity documentation. First step today: Call Humana member services (number on your ID card) to confirm Gilenya's formulary status and PA

The Complete Requirements Checklist to Get Palynziq (pegvaliase-pqpz) Covered by Aetna (CVS Health) in New Jersey

Answer Box: Getting Palynziq Covered by Aetna in New Jersey To get Palynziq (pegvaliase-pqpz) approved by Aetna (CVS Health) in New Jersey: 1) Confirm you're ≥18 with PKU and blood phenylalanine >600 µmol/L despite dietary management, 2) Submit prior authorization through Aetna's provider portal

Getting Adynovate (Antihemophilic Factor VIII) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Adynovate Coverage Adynovate (antihemophilic factor VIII, pegylated) requires prior authorization from Blue Cross Blue Shield in New Jersey. Submit PA through your plan's Medical Injectables Program with hemophilia A diagnosis, factor levels, bleeding history, and prophylaxis rationale. If denied, you have 180 days

Work With Your Doctor to Get HyperHEP (Hepatitis B Immune Globulin) Approved by Humana in New Jersey

Answer Box: Getting HyperHEP Approved by Humana in New Jersey HyperHEP (hepatitis B immune globulin) requires prior authorization from Humana Medicare Advantage plans and may be covered under Medicare Part B (not Part D) when given for post-exposure prophylaxis in clinical settings. Your fastest path: Have your doctor submit a

Do You Qualify for Firdapse (Amifampridine) Coverage by Cigna in New Jersey? Decision Tree & Next Steps

Quick Answer: Your Path to Firdapse Coverage Most likely eligible: If you have confirmed LEMS with EMG evidence, are ≥6 years old, have no seizure history, and a neurologist's prescription. First step: Have your neurologist submit prior authorization through CoverMyMeds with complete diagnostic documentation. If denied: Cigna allows

How to Get Filsuvez (Birch Triterpenes Topical Gel) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Filsuvez Coverage Cigna requires prior authorization for Filsuvez (birch triterpenes topical gel) in New Jersey. Your fastest path: 1) Have your dermatologist submit a Cigna PA form with dystrophic EB diagnosis, wound photos, and cancer screening results. 2) If denied, file an internal appeal within

Getting Rystiggo (rozanolixizumab-noli) Covered by Blue Cross Blue Shield in New Jersey: Complete Coding, Prior Authorization, and Appeals Guide

Answer Box: Your Path to Rystiggo Coverage in New Jersey Rystiggo (rozanolixizumab-noli) requires prior authorization from Blue Cross Blue Shield in New Jersey for generalized myasthenia gravis patients who are AChR or MuSK antibody positive. First step: Confirm if your plan covers it under medical benefit (J9333 billing) or specialty

How to Get Tegsedi (Inotersen) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Tegsedi Covered by Blue Cross Blue Shield in New Jersey Tegsedi (inotersen) requires prior authorization from Blue Cross Blue Shield plans in New Jersey, typically as a non-preferred specialty drug. To get coverage: (1) Your neurologist submits a PA request with hATTR polyneuropathy diagnosis, genetic testing, and

How to Get Raxone (Idebenone) Covered by Humana in New Jersey: Appeals Guide & Alternative Options

Answer Box: Getting Raxone Covered by Humana in New Jersey Quick Summary: Raxone (idebenone) is not FDA-approved in the US, making coverage challenging but possible through formulary exceptions or compassionate use. In New Jersey, you have strong appeal rights through IHCAP if initially denied. Fastest Path: 1. Request a formulary