Topic

Illinois

A collection of 223 issues

Oxbryta (Voxelotor) Coverage by Blue Cross Blue Shield in Illinois: 2024 FDA Withdrawal Impact and Alternative Options

Answer Box: Oxbryta Coverage Status in Illinois Oxbryta (voxelotor) was withdrawn from the US market by FDA in September 2024 due to safety concerns. Blue Cross Blue Shield of Illinois and all insurers now automatically deny coverage as the drug is no longer FDA-approved. No appeals or bridge coverage are

How to Get Tracleer (bosentan) Covered by Cigna in Illinois: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Tracleer (bosentan) Covered by Cigna in Illinois Cigna requires prior authorization for Tracleer (bosentan) with specific requirements including REMS enrollment, step therapy documentation, and monthly monitoring. The fastest path to approval: 1. Enroll in REMS program - Both prescriber and patient must register before submission 2. Document

Renewing Filspari (Sparsentan) Approval with UnitedHealthcare in Illinois: Annual Requirements and Timeline

Answer Box: Filspari Renewal with UnitedHealthcare in Illinois UnitedHealthcare requires annual reauthorization for Filspari (sparsentan) in Illinois, valid for 12 months. Renewal depends on documented proteinuria reduction and continued REMS compliance with quarterly liver function tests. Start the process 30-60 days before expiration through the UHC provider portal or OptumRx

Blue Cross Blue Shield Illinois Coverage for Rystiggo (Rozanolixizumab-noli): Complete Prior Authorization and Appeal Guide

Answer Box: Getting Rystiggo Covered in Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Rystiggo (rozanolixizumab-noli) with strict criteria: confirmed generalized myasthenia gravis with positive AChR or MuSK antibodies, documented failure of at least two standard treatments, and MGFA Class II-IV severity. First step today: Have your

Denied for Ilaris (Canakinumab) by Cigna in Illinois? Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Ilaris (Canakinumab) Approved by Cigna in Illinois If Cigna denied your Ilaris (canakinumab) prior authorization, you have strong appeal rights in Illinois. Most denials can be overturned with proper documentation. Here's your fastest path to approval: 1. Request peer-to-peer review with Cigna's medical

Somatuline Depot (lanreotide) Approval with UnitedHealthcare in Illinois: Complete Guide to Prior Authorization, Appeals, and Forms

Answer Box: Somatuline Depot (lanreotide) is covered by UnitedHealthcare in Illinois but requires prior authorization, specialist consultation (endocrinologist/oncologist), and documented trial/failure of octreotide in most cases. Submit through the UnitedHealthcare Provider Portal for fastest processing (3-5 business days). If denied, you have 180 days to appeal internally, then

How to Get Myalept (Metreleptin) Covered by Humana in Illinois: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Myalept Covered by Humana in Illinois Fastest path to approval: Submit Humana's prior authorization form with confirmed generalized lipodystrophy diagnosis, REMS enrollment proof, and specialist letter documenting failed conventional therapies. If denied, you have 65 days to appeal and can request Illinois external review within

How to Get Venclexta (Venetoclax) Covered by Aetna CVS Health in Illinois: Complete PA Guide and Appeal Process

Answer Box: Getting Venclexta (Venetoclax) Covered by Aetna CVS Health in Illinois Venclexta (venetoclax) requires prior authorization with Aetna CVS Health for CLL, SLL, and AML in Illinois. The fastest path to approval involves submitting complete clinical documentation including diagnosis confirmation, tumor lysis syndrome (TLS) monitoring plan, and prior therapy

How to Get Lutathera Covered by Aetna CVS Health in Illinois: Complete Prior Authorization Guide

Answer Box: Lutathera (lutetium Lu-177 dotatate) is covered by Aetna CVS Health in Illinois under the medical benefit with mandatory prior authorization. You'll need: confirmed somatostatin receptor-positive neuroendocrine tumor, documented failure of octreotide/lanreotide, and SSTR imaging results. Submit precertification 2+ weeks before treatment through Aetna's

Humana's Coverage Criteria for Eylea and Lucentis in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Eylea/Lucentis Covered by Humana in Illinois Humana requires prior authorization and often step therapy (trying bevacizumab first) for Eylea and Lucentis in Illinois. Your fastest path: 1) Have your eye doctor document your diagnosis with OCT imaging, 2) Try bevacizumab if you haven't already