Topic

New Jersey

A collection of 505 issues

Do You Qualify for Waylivra (Volanesorsen) Coverage by Blue Cross Blue Shield in New Jersey? Decision Tree & Next Steps

Answer Box: Quick Eligibility Check Getting Waylivra (volanesorsen) covered by Blue Cross Blue Shield in New Jersey requires meeting specific criteria. Since Waylivra is not FDA-approved in the US, coverage typically requires a non-formulary exception through Blue Cross Blue Shield's prior authorization process. You'll need: (1)

The Requirements Checklist to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield in New Jersey: Forms, Appeals, and PA Guide

Answer Box: Getting Enhertu Covered by Blue Cross Blue Shield in New Jersey Eligibility: HER2-positive unresectable/metastatic breast cancer or other FDA-approved HER2-expressing tumors after prior anti-HER2 therapy. Fastest path: Submit prior authorization via Horizon BCBS Provider Portal or MagellanRx (1-800-424-4508) with HER2 pathology report, treatment history, and monitoring plan.

If Vanflyta (Quizartinib) Isn't Approved by Humana in New Jersey: Formulary Alternatives & Exception Paths

Answer Box: Your Next Steps if Vanflyta Is Denied If Humana denies Vanflyta (quizartinib) for FLT3-ITD AML in New Jersey, you have two main paths: try preferred FLT3 inhibitors (midostaurin/Rydapt or gilteritinib/Xospata) that are typically formulary-covered, or file a formulary exception with detailed medical necessity documentation. Start by

How to Get Carbaglu (Carglumic Acid) Covered by Aetna CVS Health in New Jersey: Complete Guide to Forms, Appeals, and Approval

Answer Box: Getting Carbaglu Covered by Aetna CVS Health in New Jersey Quick Path to Approval: Aetna CVS Health covers Carbaglu (carglumic acid) for NAGS deficiency and specific organic acidemias with prior authorization. You'll need genetic/enzyme testing confirming diagnosis, elevated ammonia labs, and metabolic specialist documentation. Submit

Work With Your Doctor to Get Somatuline Depot (Lanreotide) Approved by Aetna CVS Health in New Jersey

Answer Box: To get Somatuline Depot (lanreotide) covered by Aetna CVS Health in New Jersey, you'll need prior authorization through CVS Specialty Pharmacy with documentation of acromegaly, GEP-NET, or carcinoid syndrome diagnosis plus any required step therapy (often octreotide trial). Submit via Availity portal or fax 1-800-323-2445 with

How to Get Increlex (Mecasermin) Covered by Humana in New Jersey: Complete Approval Guide with Forms and Timelines

Quick Answer: Increlex Coverage by Humana in New Jersey Increlex (mecasermin) requires prior authorization from Humana Medicare Advantage plans. To get approved, you need: (1) confirmed severe primary IGF-1 deficiency diagnosis from a pediatric endocrinologist, (2) documented lab values showing IGF-1 ≤3 SD below normal and normal GH stimulation test,

How to Get Xembify (Immune Globulin, SC) Covered by Aetna CVS Health in New Jersey: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Xembify Covered by Aetna CVS Health in New Jersey Xembify (immune globulin subcutaneous) requires prior authorization from Aetna CVS Health for primary immunodeficiency. Submit via Availity portal or fax (888) 267-3277 with diagnosis documentation, IgG levels, and prior treatment failures. Most approvals process within 24-48 hours. If

How to Get Cometriq (cabozantinib) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Cometriq Covered in New Jersey Cometriq (cabozantinib capsules) requires prior authorization from Blue Cross Blue Shield in New Jersey for metastatic medullary thyroid carcinoma. Your oncologist submits the PA electronically with pathology reports, imaging showing progression, and medical necessity documentation. If denied, you have 180 days to

Work With Your Doctor to Get Cresemba (Isavuconazole) Approved by Blue Cross Blue Shield in New Jersey: PA Forms, Appeals, and Medical Necessity Letters

Quick Answer: Getting Cresemba Approved by Blue Cross Blue Shield in New Jersey Eligibility: Cresemba requires prior authorization for invasive aspergillosis or mucormycosis with confirmed diagnosis and often ID specialist involvement. Fastest path: Have your infectious disease specialist submit a comprehensive medical necessity letter documenting failed voriconazole therapy or contraindications,

How to Get Tecentriq (Atezolizumab) Covered by Humana in New Jersey: Prior Authorization, Appeals, and Financial Assistance

Answer Box: Getting Tecentriq Covered by Humana in New Jersey Tecentriq (atezolizumab) requires prior authorization from Humana and is typically placed on Tier 3 or 4 specialty formulary tiers. Your oncologist must submit a PA request demonstrating medical necessity, often including documentation of failed preferred alternatives due to step therapy