Topic

New Jersey

A collection of 505 issues

How to Get Tegsedi (Inotersen) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Tegsedi Covered by UnitedHealthcare in New Jersey To get Tegsedi (inotersen) covered by UnitedHealthcare in New Jersey, you need: (1) confirmed hATTR polyneuropathy with genetic testing showing TTR mutation, (2) REMS program enrollment for both patient and prescriber, and (3) prior authorization through UnitedHealthcare's provider

How to Get Myalept (Metreleptin) Covered by Humana in New Jersey: Complete Timeline and Appeal Guide

Answer Box: To get Myalept (metreleptin) covered by Humana in New Jersey, you need prior authorization for confirmed generalized lipodystrophy. The fastest path: (1) Complete REMS enrollment (3-5 days), (2) Submit complete prior authorization with medical necessity letter via Humana provider portal, (3) If denied, file internal appeal within 65

Work With Your Doctor to Get Uptravi (selexipag) Approved by Aetna (CVS Health) in New Jersey: Complete PA Guide

Quick Answer: Getting Uptravi (selexipag) Covered by Aetna (CVS Health) in New Jersey You're eligible for coverage if you have WHO Group I pulmonary arterial hypertension with documented functional class II-IV symptoms. The fastest path to approval requires your doctor to submit a prior authorization request through Aetna&

UnitedHealthcare's Coverage Criteria for Fintepla in New Jersey: What Counts as "Medically Necessary"?

Answer Box: Get Fintepla Covered by UnitedHealthcare in New Jersey Fintepla (fenfluramine) requires prior authorization from UnitedHealthcare's OptumRx for Dravet syndrome and Lennox-Gastaut syndrome. You'll need: (1) REMS enrollment with baseline echocardiogram, (2) documented failure of at least two preferred anti-seizure medications, and (3) confirmed diagnosis

Resources to Get Naglazyme (galsulfase) Approved with UnitedHealthcare in New Jersey: Forms, Portals & Contacts

Quick Answer: Getting Naglazyme Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Naglazyme (galsulfase) through OptumRx. Submit requests via the UnitedHealthcare Provider Portal or fax to 1-844-403-1027. Required documentation includes confirmed MPS VI diagnosis via enzyme assay/genetic testing, baseline functional measures, and medical necessity letter. If

How to Get Cerezyme (imiglucerase) Covered by Aetna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cerezyme Covered by Aetna in New Jersey Aetna covers Cerezyme (imiglucerase) for confirmed Gaucher disease Types 1-3 with prior authorization. You'll need enzyme deficiency test results or genetic testing, plus documentation that Elelyso was ineffective or contraindicated. If denied, you have 180 days for internal

How to Get Kesimpta (Ofatumumab) Covered by Cigna in New Jersey: Timeline, Appeals, and Approval Scripts

Answer Box: Getting Kesimpta Covered by Cigna in New Jersey Cigna requires prior authorization for Kesimpta (ofatumumab) and typically responds within 5 business days. To get approval, you need: (1) a confirmed relapsing MS diagnosis, (2) prescription from an MS specialist or neurologist, and (3) baseline safety labs. If denied,

How to Get Arcalyst (rilonacept) Covered by Aetna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Arcalyst Covered by Aetna in New Jersey Fastest path to approval: Submit prior authorization through Availity provider portal with complete documentation including specialist consultation, prior therapy failures, and elevated inflammatory markers. Standard decisions take 45 business days; expedited reviews complete within 72 hours for urgent cases. If

Do You Qualify for Evkeeza Coverage by UnitedHealthcare in New Jersey? Decision Tree & Next Steps

Answer Box: Getting Evkeeza Covered by UnitedHealthcare in New Jersey To qualify for Evkeeza (evinacumab-dgnb) coverage by UnitedHealthcare in New Jersey, you need: (1) confirmed homozygous familial hypercholesterolemia diagnosis with genetic testing or clinical criteria, (2) documented failure or intolerance to maximally tolerated statin + ezetimibe + PCSK9 inhibitor therapy, and (3)

How to Get Amondys 45 (Casimersen) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Amondys 45 Covered by UnitedHealthcare in New Jersey Eligibility: Patients with DMD and confirmed exon 45 mutation amenable to skipping, prescribed by a neurologist or DMD specialist, with baseline functional assessments and FVC ≥50% predicted. Fastest path: Submit prior authorization through UnitedHealthcare provider portal with genetic testing,