Topic

New Jersey

A collection of 505 issues

How to Get Ozempic and Mounjaro Covered by Cigna in New Jersey: Prior Authorization, Appeals, and Medical Necessity Requirements

Answer Box: Getting Cigna Coverage for Ozempic/Mounjaro in New Jersey Eligibility: Cigna covers Ozempic and Mounjaro with prior authorization for Type 2 diabetes patients 18+ with documented A1c ≥6.5%. Both require step therapy (typically metformin first) unless contraindicated. Fastest approval path: 1) Ensure diabetes diagnosis with recent A1c

Getting Ozempic and Mounjaro Covered by UnitedHealthcare in New Jersey: 2025 Renewal Guide

Answer Box: Quick Path to Renewal To renew Ozempic or Mounjaro coverage with UnitedHealthcare in New Jersey: Submit renewal requests 60-90 days before expiration through the UnitedHealthcare Provider Portal. Required documents include recent A1c labs (within 90 days), medication adherence records, and updated medical necessity letter. Standard processing takes 15

How to Get Helixate (Antihemophilic Factor, rFVIII) Covered by Aetna CVS Health in New Jersey: Coding, Appeals, and External Review Guide

Answer Box: Getting Helixate Covered by Aetna CVS Health in New Jersey Helixate (antihemophilic factor, rFVIII) requires prior authorization from Aetna CVS Health in New Jersey. The fastest path to approval: (1) Submit PA request via Availity portal with ICD-10 code D66, complete hemophilia documentation, and factor VIII lab results

How to Get Hemlibra (emicizumab-kxwh) Covered by Aetna (CVS Health) in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Hemlibra Covered by Aetna in New Jersey Aetna (CVS Health) requires prior authorization for Hemlibra (emicizumab-kxwh) in New Jersey. To get approved: (1) Have your hematologist document congenital Hemophilia A with FVIII inhibitors ≥5 Bethesda units or severe deficiency, (2) Submit through CVS Specialty Pharmacy with complete

How to Get Cometriq (Cabozantinib) Covered by Cigna in New Jersey: Prior Authorization Forms, Appeals, and Timeline

Answer Box: Getting Cometriq Covered by Cigna in New Jersey Cometriq (cabozantinib) requires prior authorization from Cigna in New Jersey for metastatic medullary thyroid carcinoma. The fastest path to approval: (1) Have your oncologist submit complete PA documentation including pathology confirming MTC diagnosis and ICD-10 code C73, (2) Ensure prescription

Get Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in New Jersey: Forms, Appeals & Contact Guide

Answer Box: Getting Started with Imbruvica Coverage in New Jersey Imbruvica (ibrutinib) requires prior authorization from Blue Cross Blue Shield in New Jersey. Your fastest path to approval: (1) Have your doctor submit a prior authorization request through Availity Essentials with complete clinical documentation, (2) Ensure your prescription goes to

How Long Does It Take to Get Elaprase (Idursulfase) Approved by Cigna in New Jersey? Complete Timeline & Appeals Guide

Answer Box: Cigna typically approves Elaprase (idursulfase) for Hunter syndrome within 5 business days for standard prior authorization, or 24-72 hours for urgent requests in New Jersey. Submit complete documentation including enzymatic/genetic testing, weight-based dosing, and infusion monitoring plan through Cigna's provider portal. If denied, you have

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

Answer Box: Getting Adynovate Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Adynovate (bdanocog alfa pegol) in New Jersey, with step therapy typically mandating trial of preferred factor VIII products first. To get approved: 1. Submit PA documentation showing severe hemophilia A diagnosis (factor VIII activity <

How to Get Bylvay (odevixibat) Covered by Humana in New Jersey: Complete Prior Authorization & Appeals Guide

Quick Answer: Getting Bylvay (odevixibat) Covered by Humana in New Jersey Bylvay (odevixibat) requires prior authorization from Humana and must be filled through specialty pharmacy. Your fastest path to approval: (1) Confirm your diagnosis meets FDA criteria (PFIC ≥3 months or Alagille syndrome ≥12 months), (2) Submit Humana's

How to Get Juxtapid (Lomitapide) Approved by Cigna in New Jersey: 2025 Rules, Appeals, and Step Therapy Overrides

Answer Box: Fast Track to Juxtapid Coverage Getting Juxtapid (lomitapide) approved by Cigna in New Jersey requires genetic/phenotypic HoFH documentation and step therapy compliance. New Jersey's 2025 laws mandate 72-hour decisions for standard requests (24 hours urgent). If denied, you have 180 days for internal appeals, then