Topic

New Jersey

A collection of 505 issues

How to Get Evkeeza (evinacumab-dgnb) Covered by Humana in New Jersey: Forms, Appeals & Step Therapy Override

Answer Box: Fastest Path to Evkeeza Coverage Evkeeza (evinacumab-dgnb) is a nonpreferred drug under Humana's Medicare Advantage Part B step therapy requirements. You must first try Repatha (PCSK9 inhibitor) unless contraindicated. To get coverage: 1) Submit prior authorization through Humana's provider portal with documentation of Repatha

Renewing Opzelura (Ruxolitinib Cream) Coverage with Humana in New Jersey: Timeline, Documentation & Appeal Guide

Answer Box: Renewing Opzelura Coverage with Humana in New Jersey Humana typically requires annual reauthorization for Opzelura (ruxolitinib cream). Start renewal 60-90 days before expiration. Submit updated dermatology notes documenting treatment response (IGA 0/1 for atopic dermatitis or F-VASI-75 for vitiligo), adherence, and continued medical necessity. If denied, file

How to Get Evrysdi (Risdiplam) Covered by Horizon Blue Cross Blue Shield in New Jersey: PA Forms, Appeals Timeline & Success Strategies

Answer Box: Quick Path to Evrysdi Coverage Evrysdi (risdiplam) requires prior authorization from Horizon Blue Cross Blue Shield of New Jersey and must be dispensed through their specialty pharmacy network. To get approved: (1) Have your neurologist submit a PA form with genetic SMA confirmation, motor assessments, and prior therapy

How Long Does It Take to Get Krystexxa (Pegloticase) Approved by Aetna (CVS Health) in New Jersey? Timeline & Appeal Process

Answer Box: Fastest Path to Approval Getting Krystexxa (pegloticase) approved by Aetna (CVS Health) in New Jersey typically takes 3-15 business days for prior authorization, depending on documentation completeness. Key requirements include rheumatologist prescriber, documented failure of allopurinol and febuxostat (3+ months each), G6PD test results, and methotrexate co-therapy plan.

How to Get Humate-P Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Humate-P Covered by UnitedHealthcare in New Jersey Humate-P (antihemophilic factor/vWF complex) requires prior authorization from UnitedHealthcare through OptumRx. New Jersey's strengthened step therapy protections (effective January 2026) and external review system provide strong patient safeguards. First step today: Have your hematologist document your VWD

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

Answer Box: Getting Therakos CELLEX Covered by Humana in New Jersey Humana requires prior authorization for Therakos CELLEX photopheresis for cutaneous T-cell lymphoma (CTCL) and steroid-refractory graft-versus-host disease (GVHD). Submit via Humana's provider portal with definitive diagnosis, documented steroid failures, and specialist letter citing medical necessity. If denied,

How to Get Chenodal (Chenodiol) Covered by Cigna in New Jersey: Complete PA Guide with IHCAP Appeals

Answer Box: Chenodal Coverage with Cigna in New Jersey Cigna requires prior authorization for Chenodal (chenodiol) with specific imaging documentation proving radiolucent gallstones and surgical ineligibility. Submit PA request with ultrasound reports, KUB/CT showing radiolucent stones, and medical justification for surgical risk. If denied, appeal within 180 days through

How to Get Mycapssa (Octreotide Oral) Approved by Cigna in New Jersey: Complete Forms & Appeals Guide

Answer Box: Getting Started with Cigna Coverage for Mycapssa in New Jersey Mycapssa (oral octreotide) requires prior authorization from Cigna, processed through Express Scripts specialty pharmacy. The fastest approval path involves: (1) Your endocrinologist submitting electronic PA via CoverMyMeds with baseline IGF-1 labs and specialist documentation, (2) Setting up Accredo

Renewing Advate (octocog alfa) Approval with Aetna CVS Health in New Jersey: Complete Timeline and Documentation Guide

Answer Box: Renewing Advate Coverage in New Jersey Aetna CVS Health requires annual prior authorization renewal for Advate (octocog alfa) in New Jersey, submitted 2-4 weeks before expiration via the Availity portal by your hematologist or hemophilia treatment center (HTC). Essential documents include current factor VIII levels, bleeding logs, weight-based

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

Answer Box: Fast Track to Approval Evrysdi (risdiplam) requires prior authorization from Humana in New Jersey. The fastest path: Have your neurologist submit genetic testing results (SMN1 deletion confirmation), baseline motor function scores (CHOP-INTEND or HFMSE), and a medical necessity letter through Humana's provider portal. Most decisions arrive