Topic

New Jersey

A collection of 505 issues

How to Get Alecensa (Alectinib) Covered by Aetna CVS Health in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Alecensa Covered by Aetna CVS Health in New Jersey Yes, Aetna covers Alecensa (alectinib) for ALK-positive NSCLC with prior authorization. The fastest path to approval requires three essentials: confirmed ALK-positive test results, a comprehensive medical necessity letter from your oncologist, and electronic submission through CVS Caremark'

How to Get Sylvant (Siltuximab) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Sylvant Covered by UnitedHealthcare in New Jersey Sylvant (siltuximab) requires mandatory prior authorization from UnitedHealthcare for multicentric Castleman disease. Your oncologist submits the PA request through the UnitedHealthcare Provider Portal with HIV-negative/HHV-8-negative test results, complete pathology report, and clinical documentation. If denied, you have 180 days

How to Get Uplizna (Inebilizumab) Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Uplizna Covered in New Jersey For AQP4-positive NMOSD or IgG4-related disease patients: Aetna CVS Health requires prior authorization for all Uplizna prescriptions. Your neurologist must submit documentation showing AQP4-antibody positive status, previous treatment failures, and hepatitis B screening results. Standard decisions take 5-7 business days; expedited reviews

Lowering Out-of-Pocket Costs for Dupixent with Blue Cross Blue Shield in New Jersey: Copay Cards, Appeals, and Savings Strategies

Answer Box: Getting Dupixent Covered by Blue Cross Blue Shield in New Jersey Eligibility: Dupixent requires prior authorization through Blue Cross Blue Shield plans in New Jersey, with coverage approved for moderate-to-severe atopic dermatitis (IGA ≥3, EASI ≥16, ≥10% body surface area) in patients 18+ when topical treatments have failed.

The Requirements Checklist to Get Voxzogo (vosoritide) Covered by UnitedHealthcare in New Jersey: Forms, Appeals, and Timeline

Quick Answer: Getting Voxzogo Covered in New Jersey To get Voxzogo (vosoritide) covered by UnitedHealthcare in New Jersey, you need: (1) FGFR3 genetic testing confirming achondroplasia, (2) bone age X-ray showing open epiphyses within 12 months, (3) prescription from a pediatric endocrinologist or geneticist, and (4) 12+ months of baseline

Myths vs. Facts: Getting Cerezyme (Imiglucerase) Covered by Humana in New Jersey

Answer Box: Getting Cerezyme Covered by Humana in New Jersey Eligibility: Humana requires prior authorization for Cerezyme (imiglucerase) under billing code J1786 for Type 1 Gaucher disease patients. Fastest approval path: Submit complete medical necessity documentation including confirmed enzyme deficiency test results, specialist evaluation, and FDA-approved dosing plan (2.5-60

How to Get Breyanzi (lisocabtagene maraleucel) Covered by Blue Cross Blue Shield in New Jersey: Appeals, Alternatives & Success Strategies

Answer Box: Getting Breyanzi Covered in New Jersey Eligibility: Adults with relapsed/refractory large B-cell lymphoma after ≥2 lines of therapy, or CLL/SLL after ≥2 lines including BTK and BCL2 inhibitors. Fastest Path: Your oncologist submits prior authorization through Prime Therapeutics with complete treatment history and medical necessity letter.

How to Get Keytruda (Pembrolizumab) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Keytruda Covered by Cigna in New Jersey Keytruda (pembrolizumab) requires prior authorization from Cigna for all indications. Your oncologist must submit biomarker test results (PD-L1 CPS, MSI-H, or TMB-H), complete staging documentation, and prior therapy history through Cigna's provider portal or CoverMyMeds. Standard approval takes

How to Get Opsumit (Macitentan) Covered by Cigna in New Jersey: Complete Approval Guide with Forms and Appeals

Quick Answer: Cigna requires prior authorization for Opsumit (macitentan) in New Jersey. You need: (1) PAH specialist prescription, (2) right heart catheterization results, (3) monthly pregnancy testing documentation (females), and (4) prior therapy records. Submit through your doctor or EviCore portal. If denied, you have 180 days for internal appeals,

How to Get Kanuma (Sebelipase Alfa) Covered by Cigna in New Jersey: Timeline, Appeals, and Approval Guide

Answer Box: Getting Kanuma Covered by Cigna in New Jersey Kanuma (sebelipase alfa) requires prior authorization from Cigna with documented LAL-D diagnosis via enzyme activity testing and genetic confirmation. Standard approval takes 5 business days through Cigna's EviCore portal or provider submission. If denied, New Jersey's