Topic

New Jersey

A collection of 246 issues

How to Get Ocrevus (ocrelizumab) Covered by Aetna CVS Health in New Jersey: Appeals, Alternatives & Approval Strategies

Answer Box: Aetna CVS Health covers Ocrevus (ocrelizumab) for multiple sclerosis in New Jersey but requires prior authorization and often step therapy with preferred DMTs first. If denied, you have 180 days to appeal through two internal levels, then New Jersey's IHCAP external review (success rate ~50% for

How to Get Pomalyst (Pomalidomide) Covered by Cigna in New Jersey: Timeline, Appeals, and Required Forms

Answer Box: Getting Pomalyst Covered by Cigna in New Jersey Cigna requires prior authorization for Pomalyst (pomalidomide) with specific documentation: proof of ≥2 prior therapies including lenalidomide and a proteasome inhibitor, disease progression within 60 days, and REMS program enrollment. Timeline: PA decisions within 1-2 business days after complete submission.

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

Answer Box: Getting Givlaari Covered by Humana in New Jersey Most likely to qualify: Adults with confirmed acute hepatic porphyria (AHP) who've had 2+ attacks in 6 months, elevated ALA/PBG levels, and a hematologist/hepatologist prescriber. Fastest path: Submit prior authorization with attack history, lab results, and

Myths vs. Facts: Getting Garadacimab (Anti-FXIIa) Covered by Humana in New Jersey - Complete Prior Authorization Guide

Answer Box: Getting Garadacimab Covered by Humana in New Jersey Garadacimab (Andembry) requires prior authorization from Humana in New Jersey for all plans, including Medicare Advantage. The fastest path to approval: (1) Confirm HAE diagnosis with C1-INH testing, (2) Document failed/contraindicated alternatives, (3) Complete REMS training documentation. If denied,

The Requirements Checklist to Get Idelvion (albutrepenonacog alfa) Covered by Blue Cross Blue Shield in New Jersey: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Idelvion Covered by Blue Cross Blue Shield in New Jersey Eligibility: Patients with severe or moderate hemophilia B (Factor IX <5%) can get Idelvion covered by Blue Cross Blue Shield plans in New Jersey through prior authorization. Fastest path: Submit PA request with diagnosis D67, inhibitor

How to Get Tavalisse (fostamatinib) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tavalisse (fostamatinib) Covered by Cigna in New Jersey Tavalisse (fostamatinib) requires prior authorization from Cigna and is typically covered as a specialty medication for chronic ITP after failed first-line treatments. Your fastest path to approval: 1) Have your hematologist document inadequate response to corticosteroids, IVIG, or TPO

How to Get Skyrizi (risankizumab) Covered by Cigna in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Skyrizi (risankizumab) Covered by Cigna in New Jersey Eligibility: Skyrizi requires prior authorization from Cigna for moderate-to-severe plaque psoriasis, psoriatic arthritis, Crohn's disease, or ulcerative colitis. You must document failure of preferred biologics (typically TNF inhibitors like Humira) and meet severity criteria (PASI ≥10 or

Work With Your Doctor to Get Ilaris (Canakinumab) Covered by Humana in New Jersey: Prior Authorization Guide

Answer Box: Getting Started Humana requires prior authorization for Ilaris (canakinumab) in New Jersey. Your fastest path: gather documentation of failed standard treatments, work with your doctor to submit a detailed medical necessity letter, and use Humana's online portal for electronic submission (decisions within 24-72 hours). If denied,

How to Get Synagis (Palivizumab) Covered by Horizon Blue Cross Blue Shield in New Jersey: Complete Guide to Prior Authorization, Appeals, and External Review

Answer Box: Getting Synagis Covered in New Jersey To get Synagis (palivizumab) covered by Horizon Blue Cross Blue Shield in New Jersey, you need prior authorization through their specialty pharmacy network. Start by having your pediatrician submit a PA request with current cardiology or pulmonology documentation proving high-risk status. If

Do You Qualify for Signifor LAR Coverage by Blue Cross Blue Shield in New Jersey? Decision Tree & Appeal Guide

Quick Answer: Your Path to Signifor LAR Coverage Most likely to get approved: Patients with Cushing's disease or acromegaly who've failed surgery or aren't surgical candidates, with documented biochemical evidence (elevated cortisol/IGF-1) and prior treatment attempts. First step today: Contact your endocrinologist to