Topic

New Jersey

A collection of 505 issues

How to Get Juxtapid (lomitapide) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Juxtapid Covered by Blue Cross Blue Shield in New Jersey Juxtapid (lomitapide) requires prior authorization from Blue Cross Blue Shield in New Jersey for homozygous familial hypercholesterolemia (HoFH). Success requires genetic or clinical HoFH confirmation, documented failure of Repatha and Evkeeza, specialist prescriber, REMS program enrollment, and

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

Answer Box: Getting Photrexa Covered by Humana in New Jersey Humana Medicare Advantage requires prior authorization for Photrexa (riboflavin ophthalmic solution) used in corneal cross-linking for progressive keratoconus. Approval depends on documented progression (Kmax increase ≥1.0 diopter over 6-12 months) and use of FDA-approved epithelium-off protocols at certified facilities.

How to Get Photrexa (Riboflavin) Covered by Cigna in New Jersey: Prior Authorization Guide with Appeals Timeline

Answer Box: Getting Photrexa Covered by Cigna in New Jersey Photrexa (riboflavin ophthalmic solution) requires prior authorization from Cigna in New Jersey. The fastest path to approval: (1) Submit complete PA request with corneal topography showing progression, (2) Include medical necessity letter from ophthalmologist citing FDA-approved epithelium-off cross-linking protocol, (3)

How to Get Alprolix Covered by Blue Cross Blue Shield in New Jersey: Complete Guide with Forms and Appeals

Answer Box: Getting Alprolix Covered in New Jersey Alprolix requires prior authorization from Blue Cross Blue Shield (BCBS) in New Jersey. Here's your fastest path to approval: 1. Confirm eligibility: Hemophilia B diagnosis from a hematologist, documented bleeding history or severe deficiency 2. Submit PA request: Your doctor

How to Get Uptravi (Selexipag) Covered by Blue Cross Blue Shield in New Jersey: Complete Coverage Guide

Quick Answer: To get Uptravi (selexipag) covered by Blue Cross Blue Shield in New Jersey, you'll need prior authorization with WHO Group I PAH diagnosis, right heart catheterization results, 6-minute walk test, and WHO functional class documentation. Submit through Horizon BCBS portal or CoverMyMeds. If denied, use New

How to Get Dojolvi (Triheptanoin) Covered by Cigna in New Jersey: Complete PA Guide with Appeals Timeline

Answer Box: Getting Dojolvi Approved by Cigna in New Jersey Cigna requires prior authorization for Dojolvi (triheptanoin) with strict criteria: molecular confirmation of LC-FAOD, specialist prescribing, documented MCT oil failure, and comprehensive clinical documentation. Fastest path: Submit complete PA with genetic testing, specialist letter, and MCT trial documentation via Express

Myths vs. Facts: Getting Kalydeco (ivacaftor) Covered by Aetna CVS Health in New Jersey

Answer Box: Getting Kalydeco (ivacaftor) covered by Aetna CVS Health in New Jersey requires prior authorization with CFTR mutation documentation and CF specialist involvement—coverage is never automatic. Submit complete genetic testing results and clinical notes via the Availity provider portal. If denied, file internal appeals within 180 days, then

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

Answer Box: Getting Filspari Covered by Humana in New Jersey Filspari (sparsentan) requires prior authorization from Humana and is dispensed only through specialty pharmacies. To get coverage in New Jersey: 1) Complete REMS enrollment for both patient and prescriber, 2) Submit PA with biopsy-proven IgA nephropathy diagnosis, UPCR ≥0.8

How to Get Vimizim (elosulfase alfa) Covered by Humana in New Jersey: Prior Authorization Forms, Appeal Timelines & Alternative Pathways

Answer Box: Fastest Path to Vimizim Coverage Getting Vimizim (elosulfase alfa) covered by Humana in New Jersey requires prior authorization with strict medical documentation. Your prescriber must submit genetic confirmation of MPS IVA diagnosis, baseline functional assessments (6-minute walk test), and failed alternative documentation. If denied, you have 65 days

How to Get Dojolvi (Triheptanoin) Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Dojolvi Covered by Aetna CVS Health in New Jersey Dojolvi (triheptanoin) is non-formulary on Aetna CVS Health plans and requires both prior authorization and formulary exception. You'll need molecular confirmation of LC-FAOD, documented MCT oil failure/intolerance, and specialist prescriber. Submit through Aetna's