Topic

New Jersey

A collection of 505 issues

Get Ruconest Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Ruconest Covered by Aetna CVS Health in New Jersey Yes, Ruconest (C1 esterase inhibitor [recombinant]) is covered by Aetna CVS Health for acute hereditary angioedema (HAE) attacks with prior authorization. Your fastest path to approval: (1) Get your HAE specialist to complete Aetna's Ruconest precertification

How to Get Joenja (Leniolisib) Covered by Humana in New Jersey: Complete Prior Authorization Guide

Quick Answer: Getting Joenja Covered by Humana in New Jersey Joenja (leniolisib) requires prior authorization from Humana and is not on their standard formulary. To get coverage in New Jersey: 1) Have a specialist (immunologist/hematologist) confirm your APDS diagnosis with genetic testing, 2) Submit a formulary exception request with

How to Get Enbrel (Etanercept) Covered by Humana in New Jersey: Prior Authorization, Appeals, and Medical Necessity Requirements

Quick Answer: Humana requires prior authorization for Enbrel (etanercept) in New Jersey, typically with step therapy requirements. If denied, you have 65 days to appeal internally, then can pursue external review through New Jersey's IHCAP program. Start by having your rheumatologist or dermatologist submit a prior authorization request

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

Answer Box: Getting Joenja Covered by Aetna in New Jersey Getting Joenja (leniolisib) covered by Aetna (CVS Health) in New Jersey requires prior authorization with genetic testing documentation confirming APDS diagnosis. Fastest path: Submit the Aetna Medical Exception/Prior Authorization form through Availity portal or fax to 1-888-267-3277 (specialty drugs)

How to Get Lumizyme (alglucosidase alfa) Covered by UnitedHealthcare in New Jersey: Appeals Guide & Decision Tree

Quick Answer: Do You Qualify for Lumizyme Coverage? Yes, if you have confirmed Pompe disease and meet UnitedHealthcare's criteria. The fastest path: Your metabolic specialist submits prior authorization through the UHC Provider Portal with GAA enzyme test results, genetic confirmation, and baseline functional assessments. If denied, request a

The Requirements Checklist to Get Tegsedi (inotersen) Covered by Aetna (CVS Health) in New Jersey

Answer Box: Getting Tegsedi (inotersen) Covered by Aetna (CVS Health) in New Jersey Key Requirements: Confirm TTR gene mutation, specialist prescription (neurologist/geneticist), REMS enrollment, and prior authorization approval. Timeline: PA decision typically 30-45 days; appeals have 180-day deadline. First Step: Contact your prescriber to gather genetic testing results and

How to Get Somatuline Depot (Lanreotide) Covered by Humana in New Jersey: Complete Guide with Forms and Appeal Steps

Answer Box: Getting Somatuline Depot Covered by Humana in New Jersey Yes, Humana covers Somatuline Depot (lanreotide) in New Jersey with prior authorization for acromegaly, GEP-NETs, and carcinoid syndrome. Most approvals require documentation of diagnosis by an endocrinologist or oncologist, plus evidence of octreotide trial (or medical contraindication). If denied,

How to Get Pyrukynd (mitapivat) Covered by Cigna in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Pyrukynd (mitapivat) Covered by Cigna in New Jersey Fastest path to approval: Submit prior authorization through Express Scripts/Accredo with genetic confirmation of pyruvate kinase deficiency, hematologist prescription, and documented baseline anemia or transfusion history. Standard approval takes 2 business days; urgent cases within 24 hours. If

Do You Qualify for Galafold (migalastat) Coverage by UnitedHealthcare in New Jersey? Decision Tree & Appeal Guide

Answer Box: Quick Eligibility Check To qualify for Galafold (migalastat) coverage by UnitedHealthcare in New Jersey, you need: (1) confirmed Fabry disease diagnosis, (2) genetic testing showing an "amenable" GLA variant, and (3) no concurrent enzyme replacement therapy. Submit prior authorization through the UnitedHealthcare provider portal with genetic

Renewing Upstaza (Eladocagene Exuparvovec) Approval with Blue Cross Blue Shield in New Jersey: 2025 Timeline and Requirements

Answer Box: Upstaza (eladocagene exuparvovec) renewal with Blue Cross Blue Shield in New Jersey requires annual reauthorization with updated clinical documentation. Start 60-90 days before expiration. Submit: genetic confirmation, specialist letter documenting response/safety, failed conventional therapy records, and center attestation. Use your plan's specialty pharmacy portal or