Topic

Illinois

A collection of 478 issues

Denied for Kalydeco (ivacaftor) by Cigna in Illinois? How to Appeal (Templates & Timelines)

Quick Answer: Cigna requires prior authorization for Kalydeco (ivacaftor) with CFTR genetic testing proof and CF specialist documentation. Submit via CoverMyMeds or fax (855) 840-1678; standard review takes 5 business days. If denied, file internal appeal within 180 days, then Illinois external review within 4 months. Contact Illinois DOI at

Get Darzalex Covered by Cigna in Illinois: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Darzalex Covered by Cigna in Illinois Cigna requires prior authorization for both Darzalex IV and Darzalex Faspro (subcutaneous) under most commercial plans in Illinois. Submit the official PA form via CoverMyMeds or fax to (855) 840-1678. Standard approval takes 5 business days; expedited reviews process in 72

How to Get Increlex (mecasermin) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Increlex Covered by UnitedHealthcare in Illinois To get Increlex (mecasermin) covered by UnitedHealthcare in Illinois: Submit prior authorization through OptumRx with documented severe primary IGF-1 deficiency (height ≤-3 SD, IGF-1 below 5th percentile, normal/elevated GH levels) from a pediatric endocrinologist. If denied, file internal appeal within

Getting Voxzogo (Vosoritide) Approved by UnitedHealthcare in Illinois: Complete ICD-10, HCPCS, and Appeal Guide

Answer Box: Getting Voxzogo Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Voxzogo (vosoritide) in Illinois with specific documentation: confirmed achondroplasia diagnosis (ICD-10 Q77.4), open epiphyses via X-ray, patient under 18, and specialist prescription. Submit via OptumRx provider portal with complete clinical records. If denied, you have

How to Get Krystexxa (Pegloticase) Covered by Humana in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Krystexxa Coverage Yes, Humana covers Krystexxa (pegloticase) in Illinois with prior authorization for chronic refractory gout. You'll need documented failure of allopurinol AND febuxostat at maximum doses for 3+ months each, plus normal G6PD test results. Submit your PA via Humana's

How to Get Kuvan (Sapropterin) Approved by Cigna in Illinois: Complete Timeline and Appeals Guide

Answer Box: Getting Kuvan Approved by Cigna in Illinois Cigna requires prior authorization for Kuvan (sapropterin) with approval typically taking 2-5 business days when complete documentation is submitted. Key requirements include: metabolic specialist prescription, confirmed PKU diagnosis with BH4 responsiveness testing showing ≥30% phenylalanine reduction, concurrent phenylalanine-restricted diet, and documented

Renewing Orfadin (Nitisinone) Approval with Blue Cross Blue Shield in Illinois: Complete Timeline and Documentation Guide

Answer Box: Renewing Orfadin Coverage in Illinois Blue Cross Blue Shield of Illinois requires annual prior authorization renewal for Orfadin (nitisinone) with updated clinical documentation proving ongoing medical necessity. Submit renewal requests 30-60 days before expiration using the Illinois Uniform Prior Authorization Form through Prime Therapeutics, including current succinylacetone levels

Work With Your Doctor to Get Filspari (Sparsentan) Approved by Cigna in Illinois: Forms, Appeals, and Timeline

Answer Box: Getting Filspari Approved by Cigna in Illinois To get Filspari (sparsentan) covered by Cigna in Illinois, you need: (1) biopsy-proven IgA nephropathy with proteinuria ≥1.0 g/day and eGFR ≥30 mL/min, (2) documented failure/intolerance of maximized ACE inhibitor or ARB therapy for ≥90 days, and

How to Get Uplizna (Inebilizumab) Covered by Blue Cross Blue Shield of Illinois: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Getting Uplizna Covered by BCBS Illinois Blue Cross Blue Shield of Illinois (BCBSIL) requires prior authorization for Uplizna (inebilizumab), but Illinois' strong patient protection laws help secure coverage. For AQP4-positive NMOSD or IgG4-related disease, follow these steps: 1. Submit prior authorization through BCBSIL's provider portal

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

Quick Answer: Getting Increlex (mecasermin) Covered by Cigna in Illinois Cigna requires prior authorization for Increlex (mecasermin) through a pediatric endocrinologist, typically placing it on Tier 4/5 specialty formularies. Your first step: verify your plan type (HMO requires PCP referral; PPO doesn't) and gather IGF-1 labs, growth