Topic

New Jersey

A collection of 505 issues

How to Get Firazyr (Icatibant) Covered by Humana in New Jersey: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Firazyr (Icatibant) Covered by Humana in New Jersey Firazyr (icatibant) requires prior authorization from Humana and is typically covered as a specialty medication through CenterWell Specialty Pharmacy. Your prescriber must submit clinical documentation proving HAE diagnosis and medical necessity. If denied, you have 65 days to appeal,

How to Get Orkambi Covered by UnitedHealthcare in New Jersey: Appeals Guide, Forms & Timelines

Answer Box: Getting Orkambi Covered in New Jersey UnitedHealthcare requires prior authorization for Orkambi (lumacaftor/ivacaftor) in cystic fibrosis patients who are homozygous for the F508del mutation and age 1 or older. The fastest path to approval involves submitting genetic test results, CF specialist documentation, and clinical notes through OptumRx.

Aetna CVS Health Coverage for Abecma (Idecabtagene Vicleucel) in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Abecma Covered by Aetna CVS Health in New Jersey To get Abecma (idecabtagene vicleucel) covered by Aetna CVS Health in New Jersey, you must meet strict prior authorization criteria: adults 18+ with relapsed/refractory multiple myeloma after at least 2 prior lines including an immunomodulatory agent, proteasome

Get Defitelio (Defibrotide) Covered by UnitedHealthcare in New Jersey: Complete Forms and Appeals Guide

Answer Box: Getting Defitelio Covered by UnitedHealthcare in New Jersey Defitelio (defibrotide) requires prior authorization from UnitedHealthcare for coverage in New Jersey. Start by submitting a PA request through the UnitedHealthcare Provider Portal or fax to 1-844-403-1027. If denied, you have two levels of internal appeals, then can file an

How to Get Revlimid (lenalidomide) Approved by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Revlimid Covered by UnitedHealthcare in New Jersey You'll need prior authorization through OptumRx, REMS program enrollment, and detailed clinical documentation. The fastest path: 1) Verify your prescriber and pharmacy are REMS-certified, 2) Complete the UnitedHealthcare Revlimid PA notification form with diagnosis codes and prior treatment

Work With Your Doctor to Get Trikafta Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Trikafta Covered by Blue Cross Blue Shield in New Jersey Eligibility: Cystic fibrosis patients ≥2 years with documented F508del or other FDA-approved CFTR mutations. Fastest path: Your CF specialist submits prior authorization with CFTR genotype results and baseline liver function tests through Blue Cross Blue Shield'

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

Answer Box: HyperHEP (hepatitis B immune globulin) coverage by Blue Cross Blue Shield New Jersey requires prior authorization through MagellanRx Management. Submit PA requests via the Horizon Provider Portal with exposure documentation and clinical justification. If denied, you have 180 days for internal appeals and 4 months for external review

Renewing Ibrance (Palbociclib) Approval with Humana in New Jersey: Documentation, Timeline & Appeals Process

Answer Box: Quick Guide to Ibrance Renewal with Humana in New Jersey Renewing Ibrance (palbociclib) with Humana requires updated clinical documentation showing ongoing medical necessity and stable disease status. Submit renewal requests 30-45 days before your current authorization expires through CoverMyMeds or Humana's provider portal. Include recent pathology

Renewing Entresto (Sacubitril/Valsartan) Approval with Blue Cross Blue Shield in New Jersey: 2025 Requirements & Timeline

Quick Answer: Renewing Your Entresto Coverage Entresto (sacubitril/valsartan) requires annual prior authorization renewal with Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ). Start your renewal 60-90 days before expiration. You'll need updated heart failure documentation, recent LVEF results, and proof of ongoing benefit. Submit through your

How to Get Stelara (Ustekinumab) Covered by Cigna in New Jersey: Coding, Appeals, and Step Therapy Guide

Quick Answer: To get Stelara (ustekinumab) covered by Cigna in New Jersey, you'll need prior authorization with specific ICD-10 codes, documented step therapy failures, and TB screening. If denied, New Jersey's IHCAP external review program (managed by Maximus Federal Services) overturns about 68% of specialty drug