Topic

New Jersey

A collection of 46 issues

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

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Ocrevus (ocrelizumab) in New Jersey, with specific medical necessity criteria for both relapsing and primary progressive MS. The fastest path to approval: ensure you have a confirmed MS diagnosis, document any failed prior therapies, and

The Complete Guide to Getting Rezlidhia (Olutasidenib) Covered by UnitedHealthcare in New Jersey: Requirements, Appeals, and Step Therapy

Answer Box: Getting Rezlidhia Covered in New Jersey UnitedHealthcare requires prior authorization for Rezlidhia (olutasidenib) in New Jersey, with specific requirements for documented IDH1 mutation and AML diagnosis. The fastest path: (1) Submit PA through the UnitedHealthcare Provider Portal with IDH1 mutation test results, (2) Include medical necessity letter addressing

How to Get Kymriah (tisagenlecleucel) Covered by UnitedHealthcare in New Jersey: Appeals Guide with Templates

Answer Box: Getting Kymriah Covered by UnitedHealthcare in New Jersey Kymriah requires prior authorization from UnitedHealthcare/OptumRx. If denied, you have strong appeal options in New Jersey through internal reviews and the state's Independent Health Care Appeals Program (IHCAP). First step today: Contact your oncologist to request prior

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

Quick Answer: Getting Ilaris Covered by Aetna CVS Health in New Jersey Ilaris (canakinumab) requires prior authorization from Aetna CVS Health for all New Jersey members. The fastest path to approval: have your rheumatologist or immunologist complete Aetna's Ilaris precertification form with documentation of your diagnosis (Still'

How to Get Rylaze Approved by Aetna CVS Health in New Jersey: Timeline, Appeals, and Success Strategies

Answer Box: Getting Rylaze Covered by Aetna CVS Health in New Jersey Rylaze (asparaginase erwinia chrysanthemi recombinant) requires prior authorization from Aetna CVS Health. The fastest path to approval: (1) Document hypersensitivity to E. coli asparaginase with clinical notes showing reaction details, (2) Submit complete PA request via Availity portal

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

Answer Box: Your Fastest Path to Kuvan Coverage Aetna CVS Health requires prior authorization for Kuvan (sapropterin) in New Jersey. Start by having your metabolic specialist submit a PA request through Aetna's Availity portal with complete PKU documentation, baseline phenylalanine levels, and dietary management records. If denied, you

How to Get Poteligeo (mogamulizumab-kpkc) Covered by Humana in New Jersey: Complete Guide with Forms and Appeals

Quick Answer: Getting Poteligeo Covered by Humana in New Jersey Poteligeo (mogamulizumab-kpkc) requires prior authorization from Humana for cutaneous T-cell lymphoma treatment. Submit documentation through CenterWell Specialty Pharmacy showing relapsed/refractory mycosis fungoides or Sézary syndrome with prior systemic therapy failures. If denied, New Jersey's IHCAP external review

How to Get Juxtapid (lomitapide) Covered by UnitedHealthcare in New Jersey: Complete Guide with Forms and Appeals

Answer Box: Getting Juxtapid Covered by UnitedHealthcare in New Jersey Juxtapid (lomitapide) requires prior authorization from UnitedHealthcare for homozygous familial hypercholesterolemia (HoFH). First, confirm your diagnosis with genetic testing documentation. Submit the UnitedHealthcare prior authorization form through their provider portal, including proof you've tried other HoFH treatments first.

How to Get Palynziq (pegvaliase) Covered by Cigna in New Jersey: Prior Authorization Forms, Appeal Process, and REMS Requirements

Quick Answer: Getting Palynziq Covered by Cigna in New Jersey Palynziq (pegvaliase) requires prior authorization from Cigna and strict compliance with FDA REMS requirements. Your fastest path to approval: (1) Ensure your prescriber is REMS-certified and you're enrolled in the program, (2) Submit prior authorization through the Cigna

How to Get Uptravi (Selexipag) Covered by Cigna in New Jersey: Prior Authorization, Appeals, and Cost Assistance

Quick Answer: Getting Uptravi Covered by Cigna in New Jersey Uptravi requires prior authorization from Cigna and is typically dispensed through specialty pharmacy Accredo. Most denials stem from incomplete PAH documentation or missing step therapy trials. Your fastest path: Have your doctor submit Cigna's PA form with complete