Topic

New Jersey

A collection of 506 issues

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

How to Get Imbruvica (Ibrutinib) Covered by Aetna CVS Health in New Jersey: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Imbruvica (Ibrutinib) Covered by Aetna CVS Health in New Jersey Imbruvica (ibrutinib) requires prior authorization from Aetna CVS Health for all indications. Your fastest path to approval: Have your oncologist submit prior authorization with complete diagnostic documentation, prior treatment history, and medical necessity letter through the Aetna

How to Get Opdivo (Nivolumab) Covered by Humana in New Jersey: Prior Authorization, Appeals, and Alternative Options

Answer Box: Getting Opdivo Covered by Humana in New Jersey Opdivo (nivolumab) is typically covered under Humana Medicare Advantage Part B as a medical benefit, not pharmacy formulary, since it's administered by IV infusion. Prior authorization is usually required with clinical documentation showing FDA-approved indication and medical necessity.

How to Get Acthar Gel Covered by Cigna in New Jersey: Complete Guide to Prior Authorization, Appeals, and Forms

Answer Box: Getting Acthar Gel Covered by Cigna in New Jersey Acthar Gel requires prior authorization from Cigna in New Jersey. Your fastest path to approval: Have your neurologist call Cigna Pharmacy Services at (800) 882-4462 with clinical documentation showing failed corticosteroid therapy or contraindications. Submit the PA request via

How to Get Juxtapid (Lomitapide) Covered by Aetna CVS Health in New Jersey: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Juxtapid Covered by Aetna CVS Health in New Jersey Juxtapid (lomitapide) requires prior authorization from Aetna CVS Health for homozygous familial hypercholesterolemia (HoFH). Key requirements: genetic HoFH diagnosis, failed trials of high-intensity statin + ezetimibe + PCSK9 inhibitor, LDL-C ≥100 mg/dL despite treatment, and REMS program enrollment. First

How to Renew iLink® Corneal Cross-Linking Coverage with Cigna in New Jersey: Timeline, Documentation & Appeals

Answer Box: Quick Guide to iLink® Renewal with Cigna in New Jersey Cigna requires annual reapproval for iLink® corneal cross-linking with documented keratoconus progression. Start renewal preparation 60 days before your current approval expires. Submit reauthorization 2-4 weeks early with updated corneal topography, pachymetry, and ophthalmologist progress notes. If denied,

Do You Qualify for Vitrakvi (Larotrectinib) Coverage by Humana in New Jersey? Decision Tree & Next Steps

Answer Box: Getting Vitrakvi Covered by Humana in New Jersey Yes, you can get Vitrakvi (larotrectinib) covered by Humana if you have a confirmed NTRK gene fusion-positive solid tumor and meet medical necessity criteria. Fastest path: Your oncologist submits prior authorization through Humana's provider portal with NTRK fusion

Getting Mycapssa (Octreotide, Oral) Approved by UnitedHealthcare in New Jersey: A Complete Coverage Guide

Answer Box: Getting Mycapssa Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Mycapssa (oral octreotide) with specific step therapy requirements: confirmed acromegaly diagnosis, prior response to injectable octreotide or lanreotide, and clinical justification for switching to oral therapy. Submit PA requests through OptumRx portals with complete documentation.

How to Get Hetlioz (Tasimelteon) Covered by Blue Cross Blue Shield in New Jersey: Complete PA Guide & Appeals

Answer Box: Getting Hetlioz Covered by BCBS in New Jersey Hetlioz requires prior authorization from Blue Cross Blue Shield in New Jersey. The fastest path: 1) Document failed melatonin trial (6+ months), 2) Have your sleep specialist submit PA request via Horizon's provider portal, 3) Include diagnosis confirmation

Getting Ocrevus (Ocrelizumab) Covered by Blue Cross Blue Shield in New Jersey: Prior Authorization, Appeals & Cost Assistance

Answer Box: Quick Path to Ocrevus Coverage in New Jersey Blue Cross Blue Shield in New Jersey requires prior authorization for Ocrevus through their specialty management program. To get started: (1) Have your neurologist submit a PA request through MagellanRx Management or call 1-800-424-4508, (2) ensure you meet clinical criteria