Topic

New Jersey

A collection of 505 issues

How to Get Oxlumo (lumasiran) Covered by UnitedHealthcare in New Jersey: Complete Coding, Appeals, and External Review Guide

Answer Box: Getting Oxlumo (lumasiran) Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Oxlumo (lumasiran) for primary hyperoxaluria type 1 (PH1), with coverage based on genetic confirmation, specialist prescribing, and documented oxalate elevation. If denied, you have internal appeals followed by New Jersey's IHCAP external

Getting Tagrisso (Osimertinib) Covered by Cigna in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: How to Get Tagrisso Covered by Cigna in New Jersey Cigna covers Tagrisso (osimertinib) with prior authorization for EGFR-mutated NSCLC in metastatic, adjuvant, and unresectable stage III settings. No step therapy required under Cigna's national policy. To get approved: (1) Submit PA with EGFR mutation test

Requirements Checklist to Get Zokinvy (lonafarnib) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization Guide

Answer Box: Fast Track to Zokinvy Coverage To get Zokinvy (lonafarnib) covered by Blue Cross Blue Shield in New Jersey, you need: (1) confirmed HGPS or processing-deficient progeroid laminopathy diagnosis with genetic testing, (2) age ≥12 months with BSA ≥0.39 m², (3) specialist involvement, and (4) prior authorization through

Work With Your Doctor to Get Blenrep (belantamab mafodotin) Covered by Humana in New Jersey: Provider Collaboration Guide

Quick Answer: Getting Blenrep Coverage Through Doctor Partnership Current Status: Blenrep (belantamab mafodotin) was withdrawn from the U.S. market in 2022 and is under FDA review with a PDUFA date of October 23, 2025. Access is currently limited to clinical trials or expanded access programs. Fastest Path: Work with

How to Get Brineura (cerliponase alfa) Covered by Aetna (CVS Health) in New Jersey: Complete PA Guide and Appeal Process

Answer Box: Getting Brineura Covered by Aetna in New Jersey Aetna requires prior authorization for Brineura (cerliponase alfa) in New Jersey. To get coverage, you need: (1) confirmed CLN2 disease diagnosis via enzyme assay or genetic testing, (2) treatment by a neurologist experienced in intraventricular administration, and (3) no acute

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

Answer Box: Getting Kymriah Covered by Cigna in New Jersey Kymriah requires prior authorization through Cigna's LifeSOURCE transplant program, not standard pharmacy benefits. For New Jersey residents, you have strong protections under state law including step therapy exceptions (effective 2026) and external appeals through IHCAP. First step today:

Myths vs. Facts: Getting Besponsa (inotuzumab ozogamicin) Covered by Humana in New Jersey

Answer Box: Getting Besponsa Covered by Humana in New Jersey Fastest path to approval: Submit prior authorization through Evolent Health/New Century Health with complete documentation: CD22-positive B-cell ALL pathology, prior therapy failures, baseline liver function tests, and physician letter addressing hepatotoxicity monitoring. First step: Call your oncologist's

Myths vs. Facts: Getting Orkambi (lumacaftor/ivacaftor) Covered by Blue Cross Blue Shield in New Jersey

Answer Box: Getting Orkambi covered by Blue Cross Blue Shield in New Jersey requires prior authorization with documented F508del homozygous mutation, CF specialist prescription, and baseline clinical data. If denied, you have internal appeal rights plus New Jersey's Independent Health Care Appeals Program (IHCAP) through Maximus Federal within

Renewing Vimizim (Elosulfase Alfa) Approval with UnitedHealthcare in New Jersey: Timeline, Documentation, and Renewal Requirements

Answer Box: Renewing Vimizim Coverage with UnitedHealthcare in New Jersey UnitedHealthcare requires annual prior authorization renewal for Vimizim (elosulfase alfa) in New Jersey. Start the renewal process 30 days before your current approval expires. Your metabolic specialist must submit updated documentation showing continued benefit through the UHC Provider Portal, including

If Eloctate Isn't Approved by Aetna (CVS Health) in New Jersey: Formulary Alternatives & Exception Paths

Answer Box If Aetna (CVS Health) denies Eloctate in New Jersey, your fastest options are: 1) Try preferred factor VIII products like Adynovate or Jivi first (step therapy), 2) Submit a formulary exception with documented failure/intolerance of preferred agents, or 3) Switch temporarily while appealing. Submit PA requests through