Topic

Illinois

A collection of 43 issues

How to Get Vyondys 53 (Golodirsen) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Vyondys 53 Covered by Aetna CVS Health in Illinois Fastest path to approval: Submit prior authorization with genetic testing confirming exon 53 mutation, baseline kidney function labs, and neuromuscular specialist oversight. If denied, request peer-to-peer review within days, then file internal appeal within 180 days. Illinois residents
6 min read

How to Get Gattex (teduglutide) Covered by Blue Cross Blue Shield of Illinois: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Gattex Approved in Illinois To get Gattex (teduglutide) covered by Blue Cross Blue Shield of Illinois, you need prior authorization showing short bowel syndrome with parenteral nutrition dependence. Submit clinical documentation including PN logs, specialist attestation, and failed alternative therapies. If denied, you have 60 days to
6 min read

How to Get Strensiq (asfotase alfa) Covered by Cigna in Illinois: Decision Tree, Appeals, and Next Steps

Answer Box: Your Path to Strensiq Coverage in Illinois Cigna requires strict prior authorization for Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia (HPP). You qualify if you have documented perinatal, infantile, or juvenile-onset HPP with low alkaline phosphatase and genetic confirmation. Next steps: (1) Gather diagnostic proof including ALPL mutation testing,
5 min read

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Blue Cross Blue Shield in Illinois: Complete Guide with Forms and Appeal Scripts

Answer Box: To get Upstaza (eladocagene exuparvovec) covered by Blue Cross Blue Shield of Illinois, you need: (1) confirmed AADC deficiency diagnosis with genetic testing, (2) prior authorization through the BCBSIL specialty drug portal, and (3) documentation from a certified gene therapy center. Start by gathering genetic test results and
5 min read