Topic

Illinois

A collection of 424 issues

How to Get Adynovate (bdanocog alfa pegol) Covered by Cigna in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Adynovate Covered by Cigna in Illinois Adynovate requires prior authorization through Cigna's Express Scripts specialty pharmacy. In Illinois, Cigna must respond within 72 hours for standard requests or 24 hours for urgent cases. Your hematologist must document hemophilia A diagnosis (ICD-10: D66), Factor VIII activity

How to Get Pomalyst (Pomalidomide) Covered by UnitedHealthcare in Illinois: Complete PA Guide with Appeal Forms and Timelines

Answer Box: Getting Pomalyst Covered by UnitedHealthcare in Illinois Fastest Path to Approval: Pomalyst (pomalidomide) requires prior authorization from UnitedHealthcare. Your oncologist must submit clinical documentation showing you've tried and failed both lenalidomide and a proteasome inhibitor, with disease progression within 60 days of last therapy. Illinois banned

Myths vs. Facts: Getting Oxbryta (Voxelotor) Covered by Aetna in Illinois - What Patients Need to Know

Answer Box: Oxbryta Coverage Reality in Illinois Critical Update: Oxbryta (voxelotor) was voluntarily withdrawn from the U.S. market by Pfizer in September 2024 due to safety concerns. Claims are now denied due to loss of FDA approval. Illinois patients with sickle cell disease should work with their healthcare providers

How to Get Naglazyme (galsulfase) Covered by Aetna (CVS Health) in Illinois: Prior Authorization Guide, Appeal Scripts & Timeline

Answer Box: Getting Naglazyme (galsulfase) Covered by Aetna (CVS Health) in Illinois Naglazyme requires prior authorization from Aetna CVS Health. Your fastest path to approval: (1) Have your metabolic specialist submit enzyme assay or genetic testing confirming MPS VI diagnosis, (2) Request a medical necessity letter addressing Aetna's

How to Get Tremfya (Guselkumab) Covered by Blue Cross Blue Shield of Illinois: 2025 Appeal Guide with Forms and Timelines

Answer Box: Getting Tremfya Covered by BCBS Illinois Fastest path to approval: Submit prior authorization through CoverMyMeds or fax to 1-800-693-6703 with complete clinical documentation. If denied, you have strong appeal rights under Illinois law—including a ban on step therapy and binding external review within 30 days. Start today:

Get Firdapse (Amifampridine) Covered by Blue Cross Blue Shield in Illinois: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Firdapse Approved in Illinois Eligibility: Blue Cross Blue Shield Illinois covers Firdapse (amifampridine) for confirmed Lambert-Eaton myasthenic syndrome (LEMS) in patients 6+ years old with prior authorization. Fastest path: Have your neurologist submit a comprehensive PA request including LEMS diagnostic proof (antibodies or EMG), failed alternative treatments,

How to Get Strimvelis Gene Therapy Covered by UnitedHealthcare in Illinois: Complete PA Guide and Appeals Process

Answer Box: Getting Strimvelis Covered by UnitedHealthcare in Illinois Strimvelis requires prior authorization from UnitedHealthcare and faces significant coverage challenges since it's only available in Milan, Italy, and lacks FDA approval in the U.S. Your fastest path: (1) Have your immunologist submit PA with confirmed ADA-SCID diagnosis

Myths vs. Facts: Getting Cresemba (Isavuconazole) Covered by Blue Cross Blue Shield in Illinois

Answer Box: Getting Cresemba Covered in Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Cresemba (isavuconazole) with infectious disease specialist consultation. The fastest path to approval: 1) Ensure your ID specialist documents confirmed invasive aspergillosis or mucormycosis with lab evidence, 2) Submit PA request via Availity Essentials

How to Get Evkeeza (Evinacumab-dgnb) Covered by Cigna in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Evkeeza Covered by Cigna in Illinois Eligibility: Patients 5+ with confirmed homozygous familial hypercholesterolemia (HoFH) who've failed maximum statin, ezetimibe, and PCSK9 inhibitor therapy. Fastest approval path: 1) Gather genetic testing confirming HoFH, recent LDL-C levels ≥70 mg/dL on maximum therapy, and pharmacy records

How to Get Tecentriq (Atezolizumab) Covered by Aetna CVS Health in Illinois: Forms, Appeals, and Expert Tips

Quick Answer: Getting Tecentriq Covered by Aetna CVS Health in Illinois Tecentriq (atezolizumab) requires prior authorization from Aetna CVS Health. Your fastest path to approval: 1) Verify your plan covers specialty oncology drugs through CVS Specialty at 1-800-323-2445, 2) Submit complete biomarker testing (PD-L1, EGFR, ALK as applicable) with your