Topic

Illinois

A collection of 398 issues

How to Get Signifor / Signifor LAR (pasireotide) Covered by Cigna in Illinois: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Signifor/Signifor LAR Covered by Cigna in Illinois Cigna requires prior authorization for all Signifor/Signifor LAR (pasireotide) prescriptions in Illinois. For acromegaly, you must first try octreotide or lanreotide; for Cushing's disease, document surgical failure or ineligibility. Your endocrinologist must submit detailed clinical evidence
5 min read

How to Get Rebif (Interferon Beta-1a) Covered by Cigna in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rebif Covered by Cigna in Illinois Rebif (interferon beta-1a) requires prior authorization from Cigna and is subject to step therapy requirements. Treatment-naïve patients must first try dimethyl fumarate or fingolimod unless contraindicated. Your neurologist must document MS diagnosis with MRI activity, relapse history, and medical necessity. If
6 min read

Renewing Galafold (Migalastat) Coverage with UnitedHealthcare in Illinois: Timeline, Documentation, and Appeal Options

Answer Box: Renewing Galafold Coverage with UnitedHealthcare in Illinois UnitedHealthcare requires annual reauthorization for Galafold (migalastat) with documentation of positive clinical response. Submit renewal requests 30-60 days before expiration through OptumRx with specialist notes showing treatment response (reduced GL-3 levels, stable kidney function). If denied, you have 180 days for
6 min read

How to Get Hetlioz (Tasimelteon) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Hetlioz Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Hetlioz (tasimelteon) with mandatory step therapy requiring a 30-day melatonin trial failure. You'll need diagnosis documentation (Non-24 sleep disorder ICD-10 G47.24 or Smith-Magenis syndrome), specialist consultation, and submission via OptumRx specialty pharmacy. First
6 min read

The Requirements Checklist to Get Advate (octocog alfa) Covered by UnitedHealthcare in Illinois: Complete PA and Appeal Guide

Answer Box: Getting Advate Covered by UnitedHealthcare in Illinois Advate (octocog alfa) requires prior authorization through UnitedHealthcare's OptumRx with step therapy requirements favoring preferred Factor VIII products. The fastest path to approval: 1) Submit complete PA with hemophilia A diagnosis (ICD-10: D66), inhibitor-negative status, and bleeding history via
5 min read

How to Get Waylivra (volanesorsen) Covered by Humana in Illinois: Complete Guide with Forms, Appeals, and Assistance Programs

Answer Box: Getting Waylivra (volanesorsen) Covered by Humana in Illinois Waylivra (volanesorsen) requires prior authorization through Humana's formulary exception process since it's not FDA-approved in the US. Success depends on genetic confirmation of familial chylomicronemia syndrome (FCS), triglyceride levels >500 mg/dL despite standard therapies,
7 min read

A Realistic Epidiolex (Cannabidiol) Approval Scenario with Humana in Illinois (From Request to Yes)

Answer Box: Getting Epidiolex (Cannabidiol) Covered by Humana in Illinois Epidiolex requires prior authorization from Humana Medicare Advantage in Illinois for FDA-approved seizure disorders (LGS, Dravet syndrome, TSC). Submit via Humana provider portal with neurologist confirmation, failed antiseizure medication trials, EEG results, and seizure logs. Standard approval takes 14 days;
6 min read

How to Get Onivyde (Irinotecan Liposome) Covered by Cigna in Illinois: Prior Authorization, Appeals, and Renewal Guide

Quick Answer: Cigna requires prior authorization for Onivyde (irinotecan liposome) with specific clinical documentation: confirmed metastatic pancreatic adenocarcinoma, prior gemcitabine-based therapy failure (for second-line), ECOG performance status, and oncologist attestation. Submit via Cigna's Onivyde PA form with 5-day standard review. If denied, file internal appeal within 180 days,
6 min read