Topic

New Jersey

A collection of 244 issues

How to Get Duopa Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Duopa Covered by Blue Cross Blue Shield in New Jersey Duopa requires prior authorization from Blue Cross Blue Shield in New Jersey under the medical benefit (not pharmacy). Submit through your neurologist with documented advanced Parkinson's disease, ≥2-3 hours daily "OFF" time, failed

How to Get Humate-P Covered by Aetna CVS Health in New Jersey: Complete Forms, Appeals & Portal Guide

Answer Box: Getting Humate-P Covered by Aetna CVS Health in New Jersey Humate-P requires prior authorization from Aetna CVS Health for hemophilia A and von Willebrand disease treatment. Fastest approval path: Submit PA request via Aetna provider portal with recent VWF/Factor VIII labs, diagnosis confirmation, and desmopressin trial documentation

How to Get Synagis (Palivizumab) Covered by Humana in New Jersey: Complete PA Guide and Appeals Process

Quick Answer: Synagis (palivizumab) requires prior authorization from Humana in New Jersey. High-risk infants under 12 months with specific conditions (prematurity ≤35 weeks, chronic lung disease, congenital heart disease) are eligible. Submit Humana's Antiviral Monoclonal Antibodies PA form with clinical documentation. If denied, you have 65 days to

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Enhertu Covered by Aetna CVS Health in New Jersey Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Aetna CVS Health for all FDA-approved indications. The fastest path to approval: 1) Submit complete PA request with HER2 biomarker testing, prior therapy documentation, and ILD monitoring plan via Aetna provider

Mavenclad (Cladribine) Approval with Aetna CVS Health in New Jersey: Complete Coverage Guide

Answer Box: Getting Mavenclad Covered by Aetna CVS Health in New Jersey Yes, Mavenclad (cladribine tablets) is covered by Aetna CVS Health in New Jersey with prior authorization for relapsing forms of multiple sclerosis. You need documented failure of at least two disease-modifying therapies and baseline lymphocyte count ≥800 cells/

Work With Your Doctor to Get Exondys 51 (eteplirsen) Covered by UnitedHealthcare in New Jersey: Complete Guide

Answer Box: Getting Exondys 51 Covered by UnitedHealthcare in New Jersey Eligibility: Exondys 51 requires prior authorization from UnitedHealthcare for patients with Duchenne muscular dystrophy (DMD) and a confirmed mutation amenable to exon 51 skipping. Fastest approval path: 1. Ensure prescriber is a neurologist with DMD expertise 2. Gather genetic

How to Get Haegarda (C1-esterase inhibitor, SC) Covered by Aetna (CVS Health) in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Haegarda Covered by Aetna (CVS Health) in New Jersey Haegarda requires prior authorization from Aetna (CVS Health) in New Jersey. Your fastest path: 1) Have your HAE specialist complete Aetna's precertification form with HAE diagnosis confirmation (C1-INH deficiency labs), attack frequency documentation, and any prior

Getting Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in New Jersey: Complete 2025 Guide with Forms and Appeals

Answer Box: Your Path to Strimvelis Coverage in New Jersey Strimvelis gene therapy coverage through Blue Cross Blue Shield in New Jersey requires a medical exception request due to its Milan-only availability and lack of FDA approval. Success depends on thorough documentation of ADA-SCID diagnosis, failed standard treatments, and medical

Getting Orkambi (lumacaftor/ivacaftor) Covered by Cigna in New Jersey: Complete Guide to Prior Authorization, Appeals, and Templates

Answer Box: Quick Path to Coverage Cigna requires prior authorization for Orkambi (lumacaftor/ivacaftor) in New Jersey. You'll need genetic testing showing F508del homozygosity, a CF specialist prescription, and documented medical necessity. If denied, you have 180 days to appeal internally, then can request New Jersey's

How to Get Tremfya (Guselkumab) Covered by UnitedHealthcare in New Jersey: Prior Authorization Guide and Appeal Process

Answer Box: Getting Tremfya Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Tremfya (guselkumab) with step therapy involving TNF inhibitors for psoriasis/psoriatic arthritis and documented biologic failure for IBD. Your fastest path to approval: 1. Submit complete PA documentation including diagnosis codes, disease severity assessment, TB