Topic

New Jersey

A collection of 505 issues

If Pomalyst Isn't Approved by UnitedHealthcare in New Jersey: Formulary Alternatives & Exception Paths

Answer Box: Your Options When Pomalyst Is Denied If UnitedHealthcare denies Pomalyst (pomalidomide) coverage in New Jersey, you have three main paths: try formulary alternatives like Revlimid (lenalidomide), request a formulary exception with strong clinical documentation, or appeal the denial. Start by checking your plan's formulary on the

Getting Elevidys (Delandistrogene Moxeparvovec-rokl) Covered by Humana in New Jersey: Appeals Timeline and Success Strategies

Quick Answer: Getting Elevidys Covered by Humana in New Jersey Elevidys (delandistrogene moxeparvovec-rokl) requires prior authorization from Humana, with strict eligibility criteria including ambulatory status, confirmed DMD mutation, and anti-AAV antibody levels <1:400. If denied, you have 65 days to file an internal appeal, followed by New Jersey&

Myths vs. Facts: Getting Tagrisso (Osimertinib) Covered by Aetna (CVS Health) in New Jersey

Answer Box: Getting Tagrisso Covered by Aetna in New Jersey Eligibility: Tagrisso requires prior authorization from Aetna with documented EGFR mutation testing (exon 19 deletions or L858R) for metastatic or adjuvant NSCLC treatment. Fastest path: Submit PA through CVS Caremark Specialty (1-866-814-5506) with complete EGFR test results, diagnosis codes, and

How to Get Cimzia (Certolizumab Pegol) Covered by UnitedHealthcare in New Jersey: Appeals, Forms & Success Strategies

Quick Answer: Getting Cimzia Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Cimzia (certolizumab pegol) and commonly denies initial requests due to step therapy requirements. Your fastest path: Have your doctor submit a prior authorization with documentation of failed TNF inhibitors (like Humira biosimilars) and complete TB/

Myths vs. Facts: Getting Poteligeo (mogamulizumab-kpkc) Covered by Blue Cross Blue Shield in New Jersey

Answer Box: Quick Facts on Poteligeo Coverage in New Jersey Eligibility: Blue Cross Blue Shield of New Jersey covers Poteligeo (mogamulizumab-kpkc) for relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy with prior authorization through Carelon Medical Benefits Management. Fastest path: Have your oncologist or dermatologist submit

How to Get Keytruda (pembrolizumab) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide with Templates

Answer Box: Getting Keytruda Covered by Aetna CVS Health in New Jersey Yes, Keytruda (pembrolizumab) can be covered by Aetna CVS Health in New Jersey, but requires prior authorization with specific documentation. The fastest path: submit complete biomarker results (PD-L1 CPS when required), staging, and prior treatment history through Aetna&

Work With Your Doctor to Get Keppra (Levetiracetam) Approved by UnitedHealthcare in New Jersey: Provider Collaboration Guide

Answer Box: Getting Keppra Covered by UnitedHealthcare in New Jersey UnitedHealthcare typically requires prior authorization for Keppra (levetiracetam) with step therapy requirements. Your fastest path to approval: (1) Work with your neurologist to document failed alternatives and medical necessity, (2) Submit a comprehensive prior authorization through the UnitedHealthcare Provider Portal,

Renewing Nourianz (istradefylline) Approval with UnitedHealthcare in New Jersey: Documentation, Timelines, and What to Prepare

Answer Box: Renewing Nourianz Coverage in New Jersey UnitedHealthcare requires annual reauthorization for Nourianz (istradefylline) with documentation of continued clinical benefit and concurrent carbidopa/levodopa use. Start your renewal process 30-45 days before expiration to avoid therapy interruptions. Submit through the UnitedHealthcare provider portal with updated clinical notes showing reduced

Myths vs. Facts: Getting Fabrazyme (agalsidase beta) Covered by UnitedHealthcare in New Jersey

Answer Box: Getting Fabrazyme Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Fabrazyme (agalsidase beta) with genetic or biochemical confirmation of Fabry disease and specialist prescriber documentation. If denied, you have 180 days for internal appeals and can access New Jersey's Independent Health Care Appeals

How to Get Therakos CELLEX Photopheresis Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Therakos CELLEX Covered by Cigna in New Jersey Cigna requires prior authorization for Therakos CELLEX photopheresis, with strict medical necessity criteria for CTCL and steroid-refractory GVHD. In New Jersey, if denied, you have 180 days to complete internal appeals before filing an external review with Maximus through