Topic

Illinois

A collection of 424 issues

Do You Qualify for Orkambi Coverage by Cigna in Illinois? Complete Decision Tree and Appeals Guide

Answer Box: Getting Orkambi Covered by Cigna in Illinois Orkambi requires prior authorization from Cigna and F508del homozygous genetic confirmation. In Illinois, you have strong appeal rights through the state's external review process if denied. First step today: Ensure your CF specialist has your genetic test results showing

How to Get Blenrep (Belantamab Mafodotin) Covered by Cigna in Illinois: Complete Timeline and Appeal Guide

Answer Box: Getting Blenrep Covered by Cigna in Illinois Current Status: Blenrep (belantamab mafodotin) received FDA approval in July 2025 for relapsed/refractory multiple myeloma after previous market withdrawal. Timeline: Cigna typically processes specialty drug prior authorizations within 1-3 business days through Express Scripts/Accredo. First Step: Work with your

Myths vs. Facts: Getting Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in Illinois - Appeals Guide

Answer Box: Fast Track to Exondys 51 Coverage in Illinois Eligibility: Patients with confirmed DMD and exon 51-amenable mutations can get UnitedHealthcare coverage through proper documentation. Fastest path: Submit prior authorization through UnitedHealthcare's electronic portal with genetic testing, neurologist evaluation, and functional assessments. Start today: Contact your neurologist

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by UnitedHealthcare in Illinois: PA Forms, Appeals, and State Protections

Answer Box: Getting Xenpozyme Covered by UnitedHealthcare in Illinois Fastest path to approval: Submit prior authorization through OptumRx with genetic confirmation of ASMD, baseline organ assessments, and escalation protocol. If denied, Illinois law provides strong appeal protections including 30-day external review and automatic step therapy exceptions for contraindicated drugs. First

How to Get Venclexta (venetoclax) Covered by Cigna in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Venclexta Covered by Cigna in Illinois Venclexta (venetoclax) requires prior authorization through Cigna and is classified as Tier 4 specialty drug. For CLL/SLL, you must meet specific clinical criteria including age ≥18 and either prior systemic therapy or del(17p)/TP53 mutation with BTK inhibitor ineligibility.

How to Get Oxervate (Cenegermin) Covered by Cigna in Illinois: Complete Forms, Appeals & Approval Guide

Quick Answer: Getting Oxervate (Cenegermin) Covered by Cigna in Illinois Oxervate requires prior authorization from Cigna for neurotrophic keratitis treatment. Your ophthalmologist must submit a PA request through CoverMyMeds or fax (855) 840-1678 with documentation of stage 2/3 diagnosis and failed conservative treatments. Cigna covers up to 8 weeks

How to Get Evrysdi (Risdiplam) Covered by Blue Cross Blue Shield Illinois: Complete Appeal Guide with Forms and Deadlines

Answer Box: Getting Evrysdi Covered in Illinois Blue Cross Blue Shield Illinois requires prior authorization for Evrysdi (risdiplam) for SMA treatment. The fastest path to approval: 1) Have your neurologist submit a complete PA request with genetic confirmation and baseline motor assessments, 2) If denied, file an internal appeal within

Do You Qualify for Chenodal (chenodiol) Coverage by UnitedHealthcare in Illinois? Decision Tree & Next Steps

Answer Box: Getting Chenodal Covered by UnitedHealthcare in Illinois You likely qualify for Chenodal (chenodiol) coverage if you have radiolucent gallstones confirmed by imaging, cannot undergo surgery, and have tried ursodiol first (or have documented contraindications). UnitedHealthcare requires prior authorization with a 72-hour standard decision timeline. Fastest path to approval:

How to Get Lumizyme (Alglucosidase Alfa) Covered by Humana in Illinois: Coding, Prior Authorization, and Appeals Guide

Quick Answer: Getting Lumizyme Covered by Humana in Illinois Lumizyme (alglucosidase alfa) requires prior authorization from Humana and must be prescribed by a specialist familiar with Pompe disease. Use ICD-10 code E74.02 for billing, and ensure your doctor submits comprehensive documentation including enzyme testing results and genetic confirmation. If

Hetlioz LQ (Tasimelteon Oral Suspension) Approval with UnitedHealthcare in Illinois: Complete Coverage Guide

Answer Box: Getting Hetlioz LQ Covered by UnitedHealthcare in Illinois Yes, UnitedHealthcare covers Hetlioz LQ for Smith-Magenis Syndrome in children ages 3-15, but prior authorization is required. Fastest path: Have your sleep specialist submit PA through UnitedHealthcare's provider portal with genetic testing results (17p11.2 deletion or RAI1