By Counterforce Health Team in Alecensa (alectinib) —

Resources to Get Alecensa (alectinib) Approved with Cigna in Illinois: Forms, Appeals & Contact Numbers

Answer Box: Getting Alecensa (alectinib) Covered by Cigna in Illinois

Fastest path to approval: Submit prior authorization through CoverMyMeds or Accredo's specialty pharmacy portal with complete ALK+ test results, staging documentation, and prior therapy history. First step today: Call Cigna member services at 1-800-244-6224 to verify your specialty pharmacy benefit and confirm if step therapy applies. Illinois advantage: State law requires 72-hour PA decisions and guarantees external review rights through the Illinois Department of Insurance if denied.

Table of Contents

  1. Start Here: Verify Your Plan Coverage
  2. Forms You'll Need
  3. Submission Portals & Methods
  4. Specialty Pharmacy Onboarding
  5. Support Lines & Contact Numbers
  6. Appeals Process in Illinois
  7. Common Denial Reasons & Solutions
  8. When to Contact Illinois Regulators

Start Here: Verify Your Plan Coverage

Before diving into forms and appeals, confirm your Cigna plan's specialty pharmacy requirements. Alecensa (alectinib) is typically covered through Cigna's specialty pharmacy network, primarily Accredo and Express Scripts.

Coverage at a Glance

Requirement What It Means Where to Find It Source
Prior Authorization Required for most plans Member portal or call 1-800-244-6224 Cigna Contact Numbers
ALK+ Testing Must show ALK-positive NSCLC Pathology report with mutation analysis FDA-required indication
Step Therapy May require crizotinib first Plan formulary or PA form Plan-specific
Specialty Pharmacy Must use Accredo or Express Scripts Member ID card or portal Cigna Specialty Pharmacy

Call 1-800-244-6224 with your member ID to verify which specialty pharmacy manages your benefits and whether step therapy requirements apply to your specific plan.

Forms You'll Need

Prior Authorization Forms

Primary Form: Use the specialty pharmacy prior authorization process through Accredo's portal or Express Scripts. Electronic submission via CoverMyMeds is fastest, typically processing within 24-48 hours.

Required Documentation:

  • Complete ALK mutation testing results
  • Staging documentation (TNM staging, imaging reports)
  • Prior therapy history and outcomes
  • Current performance status
  • Prescriber attestation form

Exception Request Forms

If Alecensa isn't on your plan's formulary, use Cigna's Illinois-specific formulary exception form (M-25-RX-IL-981606). Under Illinois law (215 ILCS 134/45.1), Cigna must approve exceptions if:

  • The formulary drug is contraindicated
  • You previously tried and didn't tolerate the formulary drug
  • You're stable on Alecensa under a prior plan

Download the Illinois formulary exception form and submit within the required timeframe.

Submission Portals & Methods

CoverMyMeds: Fastest option for PA requests. Your oncologist can submit through their EHR system or the CoverMyMeds portal directly. Processing typically takes 24-72 hours.

Evernorth Pharmacy Drug Portal: Express Scripts' electronic PA system for providers. Requires provider registration but offers real-time status tracking.

Traditional Methods

Fax Submission:

  • Accredo Prior Authorization: 877-837-5922 (verify current number on Accredo's PA page)
  • Express Scripts: Check current fax number on provider portal

Phone Support:

  • Accredo Provider Services: 800-417-8164
  • Express Scripts: Use number on provider portal
Tip: Electronic submission through CoverMyMeds reduces processing time by 1-2 days compared to fax submission and provides automatic status updates.

Specialty Pharmacy Onboarding

Once your PA is approved, you'll need to complete specialty pharmacy onboarding:

Step-by-Step Onboarding Process

  1. Initial Contact: Accredo or Express Scripts will call within 24-48 hours of PA approval
  2. Benefits Verification: Pharmacy verifies your coverage and copay
  3. Clinical Assessment: Pharmacist reviews your treatment plan and monitoring requirements
  4. Delivery Setup: Arrange secure medication delivery to your home or clinic
  5. Education: Receive medication counseling and side effect monitoring guidance

Required Information for Onboarding

  • Insurance card and member ID
  • Prescriber contact information
  • Preferred delivery address
  • Emergency contact information
  • Current medication list

Counterforce Health helps streamline this process by ensuring all required documentation is complete before submission, reducing delays in specialty pharmacy onboarding.

Support Lines & Contact Numbers

Cigna Member Services

Primary Number: 1-800-244-6224

  • General member inquiries
  • Prior authorization status checks
  • Case management requests
  • Provider relations (ask to be transferred)

Specialty Pharmacy Support

Accredo: 800-417-8164 (providers) / Member services number on medication packaging Express Scripts Specialty: Use provider portal or main Cigna number for transfers

Illinois-Specific Support

Illinois Department of Insurance Consumer Services:

  • Toll-free: 1-877-527-9431
  • Springfield office: 1-217-782-4515
  • For external reviews and consumer complaints

Illinois Attorney General Health Care Helpline: 1-877-305-5145

  • Informal intervention with insurers
  • Consumer advocacy support

Appeals Process in Illinois

Internal Appeals with Cigna

Timeline: Submit within 180 days of denial Decision Time: 15 business days for standard appeals, 24 hours for expedited

Required Documents:

Submission Address:

  • Standard: Address on your Cigna ID card
  • Express Scripts network: PO Box 188011, Chattanooga, TN 37422

External Review (Illinois)

If Cigna upholds the denial, you have 30 days to request external review through the Illinois Department of Insurance (shorter than most states).

Process:

  1. Complete the Illinois external review form
  2. Submit Cigna's final denial letter
  3. Include all supporting medical records
  4. Illinois assigns an Independent Review Organization (IRO)
  5. Decision within 5 business days of IRO receiving materials

Contact: 1-877-527-9431 for external review assistance

From our advocates: We've seen Illinois external reviews succeed when the submission includes peer-reviewed literature supporting Alecensa's use in the patient's specific clinical scenario, particularly for adjuvant treatment or CNS metastases where the drug's unique properties are crucial.

Common Denial Reasons & Solutions

Denial Reason How to Overturn Required Documentation
Missing ALK testing Submit complete pathology report ALK fusion testing with specific mutation identified
Step therapy required Request exception or show contraindication Prior therapy failure documentation or medical contraindication
Not medically necessary Provide clinical justification Treatment guidelines, staging, performance status
Quantity limits Request override with dosing rationale Prescriber attestation for 600mg BID dosing

Medical Necessity Letter Checklist

Your oncologist's letter should include:

  • Diagnosis: ALK-positive NSCLC with specific staging
  • Prior treatments: Details of previous therapies and outcomes
  • Clinical rationale: Why Alecensa is appropriate for your case
  • Guideline support: NCCN or other recognized guidelines
  • Monitoring plan: Lab monitoring and follow-up schedule

When to Contact Illinois Regulators

Contact the Illinois Department of Insurance if:

  • Cigna doesn't respond within required timeframes
  • You believe the denial violates Illinois insurance law
  • The appeals process isn't being followed properly

Illinois Department of Insurance:

The Illinois Attorney General's office also provides consumer assistance and can intervene informally with insurance companies at 1-877-305-5145.

Frequently Asked Questions

How long does Cigna prior authorization take in Illinois? Standard PA requests: 72 hours under Illinois law. Expedited requests: 24 hours. Electronic submissions via CoverMyMeds are typically faster.

What if Alecensa isn't on my formulary? Use Cigna's Illinois formulary exception form (M-25-RX-IL-981606). Illinois law requires approval if formulary alternatives are contraindicated or previously failed.

Can I get an expedited appeal? Yes, if a delay would seriously jeopardize your health. Request expedited review when filing your appeal. Decision required within 24 hours.

Does step therapy apply if I failed crizotinib outside Illinois? Documentation of prior therapy failure should satisfy step therapy requirements regardless of where treatment occurred. Include complete treatment records.

What's the cost of Alecensa? Wholesale price is approximately $19,466 per month. Specialty pharmacy benefits typically have different copay structures than retail medications.

Update Cadence & Resource Maintenance

Check quarterly:

  • Cigna formulary updates
  • Prior authorization form versions
  • Illinois Department of Insurance contact information

Check annually:

  • Illinois insurance law changes
  • External review procedures
  • Specialty pharmacy network changes

Counterforce Health maintains current information on payer policies and forms, helping ensure submissions use the most up-to-date requirements and procedures.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Insurance coverage decisions depend on individual plan terms and medical circumstances. Always verify current forms, contact numbers, and procedures with your insurance company and healthcare providers. For personalized assistance with coverage appeals, consult with patient advocacy organizations or legal counsel familiar with Illinois insurance law.

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