Topic

New Jersey

A collection of 46 issues

How to Get Chenodal (Chenodiol) Covered by Blue Cross Blue Shield in New Jersey: Timeline, Forms & Appeal Guide

Answer Box: Getting Chenodal Covered in New Jersey Chenodal (chenodiol) requires prior authorization from Blue Cross Blue Shield in New Jersey. The fastest path to approval: 1) Have your doctor submit a PA request through Horizon's provider portal with imaging confirming radiolucent gallstones and documentation of surgical ineligibility,

Resources to Get Givlaari (givosiran) Approved with Cigna in New Jersey: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Givlaari (givosiran) Covered by Cigna in New Jersey To get Givlaari approved by Cigna in New Jersey: 1. Verify coverage through your myCigna account - most plans require Accredo specialty pharmacy 2. Submit prior authorization via CoverMyMeds or fax with specialist consultation notes, attack documentation, and elevated

Getting Vitrakvi (Larotrectinib) Covered by Cigna in New Jersey: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Vitrakvi (Larotrectinib) Covered by Cigna in New Jersey Eligibility: Cigna requires prior authorization for Vitrakvi (larotrectinib) with documented NTRK gene fusion, unresectable/metastatic solid tumors, and oncologist prescribing. Fastest path: Submit PA request via CoverMyMeds portal with NTRK fusion test results, prior therapy documentation, and medical necessity

How to Get Pomalyst (pomalidomide) Covered by Aetna CVS Health in New Jersey: Complete Coding, Appeals, and Authorization Guide

Answer Box: Getting Pomalyst (pomalidomide) Covered by Aetna CVS Health in New Jersey Pomalyst requires prior authorization from Aetna CVS Health and strict REMS compliance. Key steps: 1) Ensure proper ICD-10 coding (C90.00 for active multiple myeloma), 2) Document prior lenalidomide and proteasome inhibitor failure, 3) Submit through CVS

How to Get Orladeyo (Berotralstat) Covered by UnitedHealthcare in New Jersey: Complete Guide with Forms and Appeal Templates

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in New Jersey Orladeyo (berotralstat) requires prior authorization from UnitedHealthcare in New Jersey. To get approved: 1. Visit an HAE specialist (allergist/immunologist) who can document your hereditary angioedema diagnosis with C1-INH testing and attack frequency 2. Submit prior authorization through the UnitedHealthcare

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Cigna in New Jersey: Complete Appeals Guide

Answer Box: Getting Besponsa Covered by Cigna in New Jersey Besponsa (inotuzumab ozogamicin) requires prior authorization from Cigna with strict documentation of CD22-positive B-cell ALL diagnosis, hepatic monitoring plan, and prior therapy history. If denied, you have 180 days for internal appeals, then 4 months for New Jersey's

Work With Your Doctor to Get Lutathera (Lutetium Lu-177 Dotatate) Approved by Blue Cross Blue Shield in New Jersey

Getting Lutathera Covered: Your Path to Approval Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Blue Cross Blue Shield in New Jersey. Success depends on documenting somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs), progression on first-line somatostatin analog therapy, and meeting specific medical necessity criteria. The fastest path: work closely with

How to Get Hemlibra (emicizumab-kxwh) Covered by Cigna in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Hemlibra (emicizumab-kxwh) Covered by Cigna in New Jersey Hemlibra (emicizumab-kxwh) requires prior authorization from Cigna and is typically covered as a Tier 4 specialty drug for hemophilia A patients. To get approval in New Jersey: 1. Submit PA request through Cigna's provider portal with complete

Do You Qualify for Kanuma (Sebelipase Alfa) Coverage by UnitedHealthcare in New Jersey? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Kanuma Coverage in New Jersey Yes, you can get Kanuma (sebelipase alfa) covered by UnitedHealthcare in New Jersey if you have confirmed LAL-D diagnosis. UnitedHealthcare requires prior authorization through OptumRx with specific clinical documentation. First step today: Gather your LAL enzyme test results and

How Long Does It Take to Get Hemgenix (etranacogene dezaparvovec) Approved by Humana in New Jersey? Complete Timeline Guide

Answer Box: What You Need to Know Getting Hemgenix (etranacogene dezaparvovec) approved by Humana in New Jersey typically takes 7-30 days for standard review, or 72 hours for expedited cases. The fastest path requires complete documentation upfront: Factor IX levels ≤2%, bleeding history, genetic confirmation, and liver function tests. Start