Topic

New Jersey

A collection of 246 issues

How to Get Stelara (Ustekinumab) Covered by Cigna in New Jersey: Coding, Appeals, and Step Therapy Guide

Quick Answer: To get Stelara (ustekinumab) covered by Cigna in New Jersey, you'll need prior authorization with specific ICD-10 codes, documented step therapy failures, and TB screening. If denied, New Jersey's IHCAP external review program (managed by Maximus Federal Services) overturns about 68% of specialty drug

Myths vs. Facts: Getting Lamzede (velmanase alfa-tycv) Covered by Humana in New Jersey

Answer Box: To get Lamzede (velmanase alfa-tycv) covered by Humana in New Jersey, you need confirmed alpha-mannosidosis diagnosis, ability to walk without support, no prior bone marrow transplant, and specialist prescription. Submit prior authorization through Humana's provider portal with enzyme testing results and clinical documentation. If denied, you

How to Get Tysabri (Natalizumab) Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals & Alternatives Guide

Answer Box: Getting Tysabri Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Tysabri (natalizumab) in New Jersey, with strict documentation requirements including TOUCH program enrollment, JCV antibody testing, and MRI results. If denied, you have 180 days to file an internal appeal, followed by New Jersey'

How to Get Duopa (Carbidopa/Levodopa Enteral) Covered by Cigna in New Jersey: Complete Requirements Guide and Appeals Process

Answer Box: Getting Duopa Covered by Cigna in New Jersey Eligibility: Cigna requires prior authorization for Duopa (carbidopa/levodopa enteral) for members with advanced Parkinson's disease experiencing at least 3 hours daily of "OFF" episodes despite optimized oral therapy. Fastest Path to Approval: 1. Have your

Aetna CVS Health's Coverage Criteria for Emgality (galcanezumab-gnlm) in New Jersey: What Counts as "Medically Necessary"?

Answer Box: Getting Emgality Approved by Aetna CVS Health in New Jersey To get Emgality (galcanezumab-gnlm) covered by Aetna CVS Health in New Jersey, you must meet their step therapy requirement: documented failure, intolerance, or contraindication to at least two generic migraine preventives (typically topiramate and propranolol). Your doctor submits

Renewing Enbrel (Etanercept) Approval with Aetna CVS Health in New Jersey: Timeline, Documentation & Appeal Process

Answer Box: Renewing Your Enbrel Coverage with Aetna CVS Health in New Jersey Aetna CVS Health typically requires renewal of Enbrel (etanercept) authorization every 12 months with documentation of positive clinical response and confirmation you're not using incompatible medications. Start your renewal 60-90 days before expiration to avoid

How to Get Filsuvez (Birch Triterpenes Gel) Approved by Aetna CVS Health in New Jersey: Forms, Appeals & State Protections

Answer Box: Getting Filsuvez Approved by Aetna CVS Health in New Jersey Filsuvez (birch triterpenes topical gel) requires prior authorization from Aetna CVS Health for epidermolysis bullosa patients ≥6 months old. Your fastest path: 1) Have your EB specialist complete the Medical Exception/Prior Authorization form with genetic testing confirmation

Getting Zanzalintinib (XL092) Covered by Blue Cross Blue Shield in New Jersey: Appeal Rights, State Protections & Forms

Quick Answer: Your Path to Coverage in New Jersey Zanzalintinib (XL092) is investigational and typically denied by Blue Cross Blue Shield plans as "not medically necessary." However, New Jersey's strong patient protection laws give you powerful appeal rights. Your fastest path: 1) Request a formulary exception

Oxbryta (Voxelotor) Denied by Aetna CVS Health in New Jersey: Understanding the 2024 FDA Withdrawal and Your Appeal Options

Answer Box: Oxbryta Coverage Status Oxbryta (voxelotor) is no longer FDA-approved as of September 2024 due to increased vaso-occlusive crises and deaths in sickle cell disease patients. Aetna CVS Health now categorically denies all Oxbryta claims based on this regulatory withdrawal. Your immediate steps: 1) Contact your hematologist to plan

How to Get Keytruda (Pembrolizumab) Covered by Humana in New Jersey: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Keytruda Covered by Humana in New Jersey Keytruda (pembrolizumab) requires prior authorization from Humana in New Jersey. Your oncologist must submit clinical documentation showing FDA-approved indication, prior therapy failures, and medical necessity. If denied, you have 65 days to appeal internally, then 180 days for New Jersey&