Topic

New Jersey

A collection of 505 issues

How to Get Entresto (Sacubitril/Valsartan) Covered by Humana in New Jersey: Complete Appeals Guide with Templates

Quick Answer: Getting Entresto Covered by Humana in New Jersey Entresto requires prior authorization from Humana and is classified as a Tier 3 medication in New Jersey Medicare Advantage plans. Your fastest path to approval: (1) Have your cardiologist submit a prior authorization request with LVEF ≤40% documentation and evidence

Work With Your Doctor to Get Emgality Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Emgality Approved by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Emgality (galcanezumab-gnlm) with step therapy documentation showing failure of at least two preventive migraine treatments. The fastest path: 1) Gather records of failed preventives (topiramate, propranolol, etc.) with doses and side effects, 2) Schedule a

How to Get Alprolix (Coagulation Factor IX) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Alprolix Covered by Humana in New Jersey Alprolix (coagulation factor IX, rFIXFc; eftrenonacog alfa) requires prior authorization from Humana and faces step therapy requirements—you'll likely need to try preferred alternatives like Idelvion or BeneFIX first. If denied, you have 65 days to appeal internally,

How to Get Abecma (Idecabtagene Vicleucel) Covered by Humana in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Abecma Covered by Humana in New Jersey Abecma (idecabtagene vicleucel) requires prior authorization from Humana and must be administered at qualified CAR-T centers. For New Jersey patients, the fastest path to approval is: (1) Confirm your treatment center is Humana-approved and has CAR-T certification, (2) Have your

How to Get Vimizim (elosulfase alfa) Covered by Blue Cross Blue Shield in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Vimizim Covered by Blue Cross Blue Shield in New Jersey Vimizim (elosulfase alfa) requires prior authorization from all Blue Cross Blue Shield plans in New Jersey. Horizon BCBS, the state's largest insurer, covers Vimizim for confirmed Morquio A syndrome (MPS IVA) with documented enzyme deficiency

Get Alecensa (Alectinib) Covered by Blue Cross Blue Shield in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Alecensa Coverage in New Jersey Is Alecensa covered by Blue Cross Blue Shield in New Jersey? Yes, with prior authorization for ALK-positive non-small cell lung cancer. Fastest approval path: 1) Confirm ALK testing results are documented, 2) Submit complete prior authorization through your oncologist with

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

Answer Box: Getting Vigabatrin Covered by Aetna CVS Health in New Jersey Eligibility: Vigabatrin requires prior authorization from Aetna CVS Health for both infantile spasms (ages 1 month-2 years) and refractory complex partial seizures (ages 2+). Fastest path: Complete REMS enrollment for prescriber, patient, and CVS Specialty pharmacy, then submit

Get Sylvant (Siltuximab) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Fast Track to Sylvant Coverage Yes, Blue Cross Blue Shield covers Sylvant (siltuximab) in New Jersey for FDA-approved idiopathic multicentric Castleman disease (iMCD), but prior authorization is required. Your fastest path: (1) Ensure you have documented HIV-negative and HHV-8-negative test results, (2) Have your physician submit the PA

How to Get Gamifant (Emapalumab-lzsg) Covered by Aetna CVS Health in New Jersey: Complete Appeal Guide with Forms and Templates

Answer Box: Getting Gamifant Covered by Aetna CVS Health in New Jersey Gamifant (emapalumab-lzsg) requires prior authorization from Aetna CVS Health in New Jersey for primary hemophagocytic lymphohistiocytosis (HLH). The fastest path to approval: 1) Confirm HLH diagnosis meets HLH-2004 criteria or genetic testing, 2) Document failure of conventional therapy

How Long Does It Take to Get Darzalex Approved by Humana in New Jersey? Complete Timeline & Appeal Guide

Answer Box: Getting Darzalex Approved by Humana in New Jersey Timeline: 1-30 days for initial approval, up to 65 days if appeals are needed. Humana requires prior authorization for both Darzalex (IV) and Darzalex Faspro (subcutaneous) in New Jersey. The fastest path: have your oncologist submit a complete PA request