Topic

New Jersey

A collection of 505 issues

How to Get Ibrance (palbociclib) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Quick Answer: Cigna requires prior authorization for Ibrance (palbociclib) in New Jersey for HR+/HER2- metastatic breast cancer. Submit pathology reports proving hormone receptor status, treatment history, and combination therapy plan through Cigna's provider portal. If denied, you have 180 days for internal appeals, then 4 months for

How to Get Rapivab (peramivir) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Rapivab Coverage with Humana in New Jersey Rapivab (peramivir) requires prior authorization from Humana in New Jersey. Your fastest path to approval: Have your doctor submit the PA request through Humana's provider portal within 48 hours of flu symptom onset, documenting why oral antivirals like Tamiflu

How to Get Ruconest (C1 Esterase Inhibitor) Covered by Blue Cross Blue Shield in New Jersey: Complete Appeals Guide 2025

Answer Box: Getting Ruconest Covered in New Jersey Blue Cross Blue Shield (BCBS) requires prior authorization for Ruconest (C1 esterase inhibitor, recombinant) in New Jersey. Fastest path to approval: Submit complete documentation including confirmed HAE diagnosis (ICD-10: D84.1), lab evidence (low C4, abnormal C1-INH), and detailed medical necessity letter.

How to Get Opdivo (Nivolumab) Covered by Blue Cross Blue Shield in New Jersey: Timeline, Appeals, and Prior Authorization Guide

Answer Box: Getting Opdivo Covered by BCBS in New Jersey Blue Cross Blue Shield in New Jersey requires prior authorization for Opdivo (nivolumab) with decisions typically made within 72 hours for standard requests and 24 hours for urgent cases. The fastest path to approval involves submitting complete clinical documentation—including

How to Get Revcovi (elapegademase) Approved by Aetna CVS Health in New Jersey: Complete Prior Authorization Guide

Quick Answer: Getting Revcovi Approved by Aetna CVS Health in New Jersey Revcovi (elapegademase) requires prior authorization from Aetna CVS Health for ADA-SCID treatment. Your fastest path to approval: (1) Confirm ADA-SCID diagnosis with genetic testing or enzyme activity <1% normal, (2) Have your immunologist submit PA with documented

Getting Gamifant (Emapalumab-lzsg) Covered by Blue Cross Blue Shield in New Jersey: Timeline, Appeals & Forms

Answer Box: Getting Gamifant Covered in New Jersey Blue Cross Blue Shield in New Jersey requires prior authorization for Gamifant (emapalumab-lzsg) with strict HLH-2004 diagnostic criteria and documented conventional therapy failure. Here's your fastest path: 1. Gather documentation: HLH-2004 criteria (≥5 of 8), genetic testing results, and detailed

Myths vs. Facts: Getting Bavencio (avelumab) Covered by Aetna (CVS Health) in New Jersey - Complete Prior Authorization Guide

Answer Box: Getting Bavencio (avelumab) Covered by Aetna (CVS Health) in New Jersey Bavencio (avelumab) requires prior authorization from Aetna (CVS Health) for both Merkel cell carcinoma and urothelial carcinoma. The fastest path to approval involves three steps: (1) Submit complete prior authorization paperwork via Aetna's provider portal

How to Get Voydeya (Danicopan) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide

Answer Box: Getting Voydeya (Danicopan) Covered by Aetna CVS Health in New Jersey Voydeya (danicopan) is not on Aetna's standard formularies for 2024, requiring a formulary exception request with comprehensive clinical documentation. The fastest path to approval involves: (1) Your hematologist submits a detailed prior authorization form with

Get Tremfya (Guselkumab) Covered by Blue Cross Blue Shield in New Jersey: Complete 2025 Guide

Answer Box: Getting Tremfya Covered in New Jersey Yes, Tremfya (guselkumab) can be covered by Blue Cross Blue Shield in New Jersey, but it requires prior authorization and typically involves step therapy with TNF inhibitors first. Here's your fastest path to approval: 1. Complete TB screening and gather

Renewing Lutathera Coverage with Cigna in New Jersey: Annual Requirements, Documentation, and Appeal Process

Answer Box: Lutathera renewal with Cigna requires annual reauthorization with comprehensive clinical documentation showing continued response and no disease progression. Submit renewal requests 30-45 days before your current authorization expires. Include updated imaging reports, lab results, oncologist notes, and confirmation you haven't exceeded the 4-dose lifetime limit. If