Topic

Illinois

A collection of 424 issues

How to Get Nucala (Mepolizumab) Covered by Cigna in Illinois: Complete Prior Authorization Guide with Appeals

Answer Box: Getting Nucala (Mepolizumab) Covered by Cigna in Illinois Fastest path to approval: Submit Cigna's prior authorization form with blood eosinophil count ≥150 cells/μL (recent) or ≥300 cells/μL (past year), proof of current systemic corticosteroid use for 4+ weeks, and prescriber credentials from an allergist,

How to Get Tremfya (Guselkumab) Covered by Cigna in Illinois: Complete PA Guide and Appeal Timeline

Answer Box: Getting Tremfya Covered by Cigna in Illinois Who qualifies: Adults with moderate-to-severe plaque psoriasis, psoriatic arthritis, Crohn's disease, or ulcerative colitis who meet Cigna's clinical criteria. Fastest approval path: Submit prior authorization through your specialist (dermatologist for psoriasis, gastroenterologist for IBD) with documentation of

Myths vs. Facts: Getting Enbrel (Etanercept) Covered by Humana in Illinois

Answer Box: Fast Track to Enbrel Coverage with Humana in Illinois Myth: If your doctor prescribes Enbrel, Humana must cover it. Fact: Enbrel requires prior authorization as a Tier 5 specialty medication with step therapy requirements favoring biosimilars first. To get approved: 1) Complete TB and hepatitis B screening within

How to Get Myozyme (Alglucosidase Alfa) Covered by Humana in Illinois: Prior Authorization Forms, Appeal Timelines, and Success Strategies

Quick Answer: To get Myozyme (alglucosidase alfa) covered by Humana in Illinois, you'll need prior authorization with confirmed Pompe disease diagnosis (GAA enzyme activity <40% normal), documented specialist care, and proper dosing justification. Submit through Humana's provider portal at 866-488-5995. If denied, you have 65

How to Get Dojolvi (Triheptanoin) Covered by Aetna CVS Health in Illinois: Complete Appeals Guide and Required Documentation

Answer Box: Getting Dojolvi Covered by Aetna CVS Health in Illinois Aetna CVS Health requires prior authorization for Dojolvi (triheptanoin) as it's not on standard formularies. Success requires molecular confirmation of LC-FAOD, specialist prescription, and documented MCT oil discontinuation. First step today: Contact your metabolic specialist to gather

Renewing Revlimid (Lenalidomide) Coverage with Aetna CVS Health in Illinois: Complete Approval Guide

Answer Box: Getting Revlimid Covered by Aetna CVS Health in Illinois Revlimid requires prior authorization from Aetna CVS Health. Your prescriber must be REMS-certified and submit complete documentation including diagnosis confirmation, prior treatment history, and current lab results. Standard approval takes up to 15 days; expedited review is available within

The Requirements Checklist to Get Exondys 51 (Eteplirsen) Covered by Blue Cross Blue Shield in Illinois

Answer Box: Getting Exondys 51 Covered in Illinois Fastest path to approval: Submit prior authorization with genetic testing confirming exon 51-amenable DMD mutation, specialist prescription, and 6-minute walk test results. First step today: Contact your neurologist or neuromuscular specialist to initiate genetic testing if not completed. Blue Cross Blue Shield

Getting Signifor LAR (Pasireotide) Covered by Humana in Illinois: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Signifor LAR Covered by Humana in Illinois Eligibility: Signifor LAR (pasireotide) requires prior authorization from Humana for Cushing's disease (when surgery isn't an option/curative) and acromegaly (inadequately controlled after surgery/first-generation SSA failure). Fastest path: Submit comprehensive medical necessity documentation with biochemical

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Blue Cross Blue Shield Illinois: Complete PA Guide with ICD-10 Codes and Appeals

Answer Box: Getting Vyndaqel/Vyndamax Covered in Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Vyndaqel/Vyndamax (tafamidis) with confirmed ATTR-CM diagnosis, appropriate NYHA class, and AL amyloidosis exclusion. Fastest approval path: Have your cardiologist submit PA with PYP scan results (grade 2-3 uptake) or biopsy, negative

Renewing Kanuma (Sebelipase Alfa) Approval with Blue Cross Blue Shield in Illinois: Complete Reauthorization Guide

Answer Box: Renewing Kanuma Coverage in Illinois Blue Cross Blue Shield of Illinois requires annual reauthorization for Kanuma (sebelipase alfa). Start the renewal process 45-60 days before your current authorization expires. You'll need updated clinical documentation showing continued medical necessity, including recent lab values (ALT, AST, lipid profile)