Topic

New Jersey

A collection of 245 issues

How to Get Berinert (C1-esterase inhibitor, IV) Covered by Blue Cross Blue Shield in New Jersey: Complete Approval Guide

Answer Box: Getting Berinert Covered in New Jersey Berinert (C1-esterase inhibitor, IV) requires prior authorization from Blue Cross Blue Shield in New Jersey. Success depends on proper HAE diagnosis documentation, attack history, and clinical justification for 20 units/kg dosing per FDA labeling. Fastest path to approval: 1. Gather HAE

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

Quick Answer: Getting Revlimid Covered by Humana in New Jersey Humana requires prior authorization for Revlimid (lenalidomide) in New Jersey, with strict REMS program compliance mandatory. Your fastest path to approval: 1) Verify both your prescriber and specialty pharmacy are REMS-certified, 2) Submit complete prior authorization with diagnosis documentation and

How to Get Ultomiris (Ravulizumab) Approved by Blue Cross Blue Shield in New Jersey: Timeline, Appeals, and Documentation Guide

Answer Box: Getting Ultomiris Covered by Blue Cross Blue Shield in New Jersey Ultomiris (ravulizumab) requires prior authorization from Blue Cross Blue Shield in New Jersey and is typically classified as non-preferred on most formularies. The fastest path to approval involves: 1) Gathering complete diagnostic documentation (lab results, vaccination records,

How to Get Strimvelis Gene Therapy Covered by Humana in New Jersey: Complete Forms & Appeals Guide

Answer Box: Getting Strimvelis Covered by Humana in New Jersey Strimvelis is not FDA-approved in the U.S. and requires treatment in Milan, Italy. Humana Medicare Advantage and commercial plans do not cover international treatments. Your path forward: (1) Request a formulary exception through your prescriber, (2) If denied, appeal

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

Quick Answer: Opsumit (macitentan) requires prior authorization from Aetna CVS Health in New Jersey. Submit your PA request online via the Availity portal with complete PAH documentation, specialist notes, and prior therapy records. If denied, you can appeal internally (60 days) then request external review through New Jersey's

How to Get Berinert (C1-esterase inhibitor, IV) Covered by Humana in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Berinert Covered by Humana in New Jersey Berinert requires prior authorization from Humana for hereditary angioedema (HAE) acute attacks only—not prophylaxis. You'll need documented HAE diagnosis, step therapy completion (trying icatibant or ecallantide first), and specialist approval. If denied, New Jersey's Independent

Do You Qualify for Onpattro (patisiran) Coverage by Aetna (CVS Health) in New Jersey? Decision Tree & Next Steps

Answer Box: Getting Onpattro (patisiran) Covered by Aetna (CVS Health) in New Jersey Most likely to get approved: Patients with confirmed hATTR polyneuropathy (genetic testing required), neurologist evaluation, documented baseline mNIS+7 and 6-minute walk test scores, and no concurrent use of other hATTR medications. First step today: Have your

Denied for Rebif (Interferon Beta-1a) by UnitedHealthcare in New Jersey? How to Appeal (Templates & Timelines)

Answer Box: Getting Rebif Covered by UnitedHealthcare in New Jersey Fastest path to approval: Submit prior authorization through OptumRx with complete clinical documentation including MS diagnosis (ICD-10 G35), MRI results, prior DMT failures, and neurologist prescription. If denied, schedule a peer-to-peer review within 24 hours, then file internal appeal within

How to Get Fabrazyme (Agalsidase Beta) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Quick Answer: Fabrazyme requires prior authorization with Cigna in New Jersey. Submit genetic/biochemical confirmation of Fabry disease, specialist documentation, and medical necessity letter via CoverMyMeds or Cigna portal. Standard review takes 5 business days. If denied, appeal through Cigna's internal process, then New Jersey's IHCAP

Getting Raxone (Idebenone) Covered by UnitedHealthcare in New Jersey: Prior Authorization Guide and Appeal Process

Answer Box: Getting Raxone Covered by UnitedHealthcare in New Jersey Raxone (idebenone) requires prior authorization from UnitedHealthcare and faces coverage challenges since it's not FDA-approved in the US. Your fastest path: 1) Submit a comprehensive medical exception request through OptumRx with clinical trial evidence and failed alternative documentation,