Topic

New Jersey

A collection of 505 issues

Getting Helixate Factor VIII Covered by Cigna in New Jersey: Prior Authorization, Appeals, and Cost Assistance Guide

Quick Answer: Getting Helixate Covered by Cigna in New Jersey Helixate requires prior authorization and is typically non-formulary on Cigna plans. Your hematologist must submit comprehensive documentation including hemophilia A diagnosis (ICD-10: D66), recent Factor VIII levels, inhibitor status, and clinical justification. Standard review takes 72 hours; expedited review takes

How to Get Oxlumo (Lumasiran) Covered by Blue Cross Blue Shield in New Jersey: Complete PA Guide with Appeals Process

Answer Box: Getting Oxlumo Covered by Blue Cross Blue Shield in New Jersey Oxlumo (lumasiran) requires prior authorization from Blue Cross Blue Shield in New Jersey for primary hyperoxaluria type 1 (PH1). Your fastest path to approval: 1. Confirm PH1 diagnosis with AGXT genetic testing or liver biopsy showing AGT

How to Get Poteligeo (mogamulizumab-kpkc) Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Poteligeo Covered by UnitedHealthcare in New Jersey Fastest Path to Approval: Poteligeo (mogamulizumab-kpkc) requires prior authorization from UnitedHealthcare through OptumRx for mycosis fungoides or Sézary syndrome. Submit your request through the UnitedHealthcare Provider Portal with complete pathology reports, staging workup, and documented failure of at least one

How to Get Jynarque (tolvaptan) Covered by Blue Cross Blue Shield in New Jersey: Complete PA Guide, Appeals, and REMS Requirements

Answer Box: Getting Jynarque Covered in New Jersey Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) requires prior authorization for Jynarque (tolvaptan) with strict ADPKD progression criteria. You need documented rapid kidney decline (eGFR drop ≥3.0 mL/min/1.73m²/year or Mayo Class 1C-1E), REMS program enrollment,

Myths vs. Facts: Getting Berinert (C1-esterase inhibitor, IV) Covered by UnitedHealthcare in New Jersey

Quick Answer: Getting Berinert Covered by UnitedHealthcare in New Jersey Yes, UnitedHealthcare covers Berinert for hereditary angioedema (HAE) attacks in New Jersey, but requires prior authorization and step therapy. You'll typically need to try Ruconest first unless contraindicated. Key requirements: confirmed HAE diagnosis (ICD-10 D84.1), specialist prescription,

How to Get Orladeyo (berotralstat) Covered by Cigna in New Jersey: Complete Appeals Guide

Answer Box: Getting Orladeyo (berotralstat) Covered by Cigna in New Jersey Fastest path to approval: Submit prior authorization through Cigna's Express Scripts portal with HAE diagnosis confirmation (C1-INH deficiency labs), specialist prescription, and attack frequency documentation. If denied, file internal appeal within 180 days, request peer-to-peer review, then

Work With Your Doctor to Get Prolastin-C Approved by UnitedHealthcare in New Jersey: Provider Partnership Guide

Answer Box: Your Partnership Path to Prolastin-C Approval Getting Prolastin-C covered by UnitedHealthcare in New Jersey requires strong collaboration with your doctor. You need documented severe alpha-1 antitrypsin deficiency (Pi*ZZ genotype), emphysema evidence, and failed step therapy alternatives. Your fastest path: (1) Schedule a pre-authorization visit to gather all

How Long Does It Take to Get Daybue (trofinetide) Approved by Humana in New Jersey? Complete Timeline & Appeal Guide

Quick Answer: Humana processes Daybue (trofinetide) prior authorization requests within 14 calendar days in 2024 (7 days starting January 2025) with a low 3.5% denial rate. Required: genetic testing confirming Rett syndrome, specialist attestation, and clinical severity scoring. If denied, you have 65 days for internal appeal, then 4

Getting Eloctate Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Eloctate covered by Blue Cross Blue Shield in New Jersey, your hematologist must submit a prior authorization request with hemophilia A diagnosis confirmation, bleeding history, and medical necessity justification. Under New Jersey's 2025 laws, BCBS must respond within 72 hours for standard requests or

How to Get Skyrizi (Risankizumab) Covered by UnitedHealthcare in New Jersey: Prior Authorization Guide with Appeals Process

Answer Box: Getting Skyrizi Covered by UnitedHealthcare in New Jersey Quick Path to Approval: Skyrizi (risankizumab) requires prior authorization from UnitedHealthcare. You'll need documented failure of topical treatments (for psoriasis) or TNF inhibitors like Humira (for psoriatic arthritis/IBD), plus tuberculosis screening. If denied, New Jersey's