Topic

Illinois

A collection of 43 issues

How to Get Myozyme (alglucosidase alfa) Covered by Blue Cross Blue Shield of Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Myozyme Covered by BCBS Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Myozyme (alglucosidase alfa) for Pompe disease treatment. The fastest path to approval involves three key steps: (1) Submit complete diagnostic documentation including GAA enzyme assay and genetic testing results, (2) Have your

How to Get Humate-P Covered by Cigna in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Approval Humate-P requires prior authorization from Cigna in Illinois. Submit the Hemophilia Factor VIII Prior Authorization Form through CoverMyMeds or fax to Accredo at 855-840-1678. Include: diagnosis confirmation, von Willebrand disease subtype documentation, and proof of desmopressin trial/failure (unless contraindicated for your VWD type)

How to Get Adynovate (Antihemophilic Factor) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Adynovate Covered by Aetna CVS Health in Illinois Adynovate requires prior authorization from Aetna CVS Health in Illinois. Submit requests through the Availity portal with complete hemophilia A documentation including Factor VIII activity levels, bleeding history, and medical necessity justification. If denied, you have 180 days to

Getting Takhzyro (Lanadelumab) Covered by Humana in Illinois: Complete Coverage Guide with Forms and Appeal Process

Answer Box: Your Fastest Path to Takhzyro Coverage Takhzyro (lanadelumab-flyo) requires prior authorization from Humana in Illinois. You'll need confirmed HAE Type I/II diagnosis (low C4 and C1-INH levels), documented attack frequency, and proof of failure/contraindication to Haegarda or similar prophylaxis. Start today by: (1) gathering

Getting Filsuvez (Birch Triterpenes Topical Gel) Covered by Humana in Illinois: Complete Guide to Prior Authorization and Appeals

Answer Box: Your Fastest Path to Filsuvez Coverage Filsuvez (birch triterpenes topical gel) requires prior authorization from Humana in Illinois. Your prescriber must submit clinical documentation proving epidermolysis bullosa diagnosis (junctional or dystrophic) and failed standard wound care therapies. If denied, you have 65 days to appeal and can request

Get Firdapse (Amifampridine) Covered by UnitedHealthcare in Illinois: Complete Requirements Checklist

Answer Box: Getting Firdapse Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Firdapse (amifampridine) to treat Lambert-Eaton myasthenic syndrome (LEMS). The fastest path to approval: (1) Confirm your neurologist has documented LEMS diagnosis with antibody testing and EMG findings, (2) Submit the UnitedHealthcare prior authorization form with clinical

How to Get Carbaglu (Carglumic Acid) Covered by Cigna in Illinois: Appeals Guide with Forms and Timelines

Answer Box: Getting Carbaglu Covered by Cigna in Illinois Fastest path to approval: Submit prior authorization with genetic/biochemical confirmation of NAGS deficiency, elevated plasma ammonia levels, and specialist consultation. If denied, file internal appeal within 180 days, then external review within 30 days of final denial through Illinois Department

How to Get Elelyso (Taliglucerase Alfa) Covered by Aetna CVS Health in Illinois: Complete Guide with Forms, Timelines, and Appeal Scripts

Answer Box: Quick Path to Elelyso Coverage Elelyso (taliglucerase alfa) requires prior authorization from Aetna CVS Health in Illinois. Submit your PA request at least two weeks in advance via the Availity provider portal with complete Gaucher disease Type 1 documentation. Good news: Illinois banned step therapy for specialty medications

How to Get Eylea or Lucentis Covered by Blue Cross Blue Shield in Illinois: Complete Appeals Guide

Quick Answer: Getting Eylea or Lucentis Approved in Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Eylea (aflibercept) and Lucentis (ranibizumab) under most Medicare Advantage and government plans as of 2024. You'll likely need to try bevacizumab (Avastin) first due to step therapy requirements. Your

How to Get Cometriq (Cabozantinib) Covered by Humana in Illinois: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Cometriq (Cabozantinib) Covered by Humana in Illinois Cometriq requires prior authorization from Humana for medullary thyroid carcinoma (MTC). The fastest path: Your oncologist submits clinical documentation with ICD-10 code C73, pathology confirming MTC, and prior treatment history to Humana's provider portal or fax 877-486-2621. If