Topic

Illinois

A collection of 424 issues

Myths vs. Facts: Getting Ozempic and Mounjaro Covered by UnitedHealthcare in Illinois (2025 Appeal Guide)

Quick Answer: What Really Gets Ozempic/Mounjaro Covered by UnitedHealthcare in Illinois The Reality: UnitedHealthcare requires prior authorization for both Ozempic and Mounjaro, covering them primarily for FDA-approved diabetes indications—not automatic weight loss coverage. In Illinois, you have strong appeal rights including external review within 30 days of denial.

How to Get iLink® Corneal Cross-Linking Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting iLink® Covered by Aetna CVS Health in Illinois Eligibility: Aetna CVS Health covers FDA-approved iLink® corneal cross-linking for progressive keratoconus when you have documented disease progression via serial corneal topography (3-6 months apart) and minimum 400-micron corneal thickness. Fastest Path: 1) Gather serial topography and pachymetry from

Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Humana in Illinois: Complete Prior Authorization Guide with ICD-10 Codes and Appeal Steps

Answer Box: Getting Hemgenix Covered by Humana in Illinois Hemgenix (etranacogene dezaparvovec) requires prior authorization from Humana Medicare Advantage in Illinois. You'll need ICD-10 code D67 (hereditary factor IX deficiency), documentation of severe hemophilia B with ≤2% factor IX activity, and treatment at a CSL Behring-approved center of

How to Get Dojolvi (Triheptanoin) Covered by UnitedHealthcare in Illinois: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Dojolvi Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD and discontinuation of MCT oil. If denied, Illinois residents have strong appeal rights including internal appeals (180 days) and external review (4 months from final denial). Start today: 1)

How to Get Opfolda (miglustat) Covered by Aetna (CVS Health) in Illinois: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Opfolda (miglustat) Covered by Aetna (CVS Health) in Illinois Opfolda (miglustat) requires prior authorization from Aetna (CVS Health) and must be prescribed with Pombiliti for adults with late-onset Pompe disease (LOPD) who aren't improving on current enzyme replacement therapy. Your first step: have your specialist

How to Get Tysabri (natalizumab) Covered by Blue Cross Blue Shield of Illinois: Complete PA Guide with Forms and Appeal Process

Answer Box: Getting Tysabri Covered by BCBS Illinois Tysabri (natalizumab) requires prior authorization from Blue Cross Blue Shield of Illinois, plus mandatory enrollment in the FDA's TOUCH program. The fastest path: 1) Enroll in TOUCH at touchprogram.com, 2) Have your neurologist submit PA through the BCBS Illinois

Work With Your Doctor to Get Orfadin (Nitisinone) Covered by Humana in Illinois: Complete Provider Partnership Guide

Answer Box: Getting Orfadin (Nitisinone) Covered by Humana in Illinois Fast Track to Approval: Humana requires prior authorization for Orfadin (nitisinone) with decisions within 72 hours. Your doctor must submit biochemical proof of hereditary tyrosinemia type 1 (elevated succinylacetone levels), genetic testing results when available, and a dietary management plan

How to Get Naglazyme (galsulfase) Covered by Cigna in Illinois: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Naglazyme (galsulfase) Covered by Cigna in Illinois Cigna requires prior authorization for Naglazyme (galsulfase) with confirmed MPS VI diagnosis via enzyme assay or genetic testing. Your doctor must submit clinical documentation to Cigna's specialty pharmacy division, typically through Accredo. If denied, you have 180 days

Getting Tegsedi (Inotersen) Covered by Humana in Illinois: Complete Guide to Prior Authorization and Appeals

Answer Box: Your Fastest Path to Tegsedi Coverage To get Tegsedi (inotersen) covered by Humana in Illinois: First, ensure you and your prescriber are enrolled in the mandatory REMS program at tegsedirems.com. Submit a formulary exception request with genetic testing confirming TTR mutation, detailed neurological documentation, and a comprehensive

How to Get Ruconest Covered by Cigna in Illinois: Decision Tree, Appeals Process & Required Forms

Answer Box: Quick Qualification Check Most likely to get approved: You have confirmed HAE Type I or II with documented C1-INH deficiency (<50% normal) and C4 deficiency, prescribed by an allergist/immunologist, for acute attacks only (not prevention). Fastest path: Submit prior authorization through CoverMyMeds portal with complete lab