Topic

Illinois

A collection of 424 issues

Humana's Coverage Criteria for Eylea and Lucentis in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Eylea/Lucentis Covered by Humana in Illinois Humana requires prior authorization and often step therapy (trying bevacizumab first) for Eylea and Lucentis in Illinois. Your fastest path: 1) Have your eye doctor document your diagnosis with OCT imaging, 2) Try bevacizumab if you haven't already

How to Get Koselugo (Selumetinib) Covered by Cigna in Illinois: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Koselugo (Selumetinib) Covered by Cigna in Illinois Koselugo requires prior authorization from Cigna for pediatric patients (≥2 years) with NF1 and symptomatic, inoperable plexiform neurofibromas. Start with your prescriber submitting a PA through CoverMyMeds or Accredo's portal with complete NF1 documentation, baseline LVEF results, and

Getting HyperHEP Covered by Cigna in Illinois: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting HyperHEP Covered by Cigna in Illinois HyperHEP (hepatitis B immune globulin) is covered by Cigna as a Tier 4 specialty drug with prior authorization required. In Illinois, you have strong appeal rights including external review within 30 days of denial. Fastest path to approval: 1. Doctor submits

Aetna (CVS Health) Coverage Criteria for Joenja (leniolisib) in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Joenja (leniolisib) Covered by Aetna (CVS Health) in Illinois Aetna (CVS Health) requires prior authorization for Joenja (leniolisib) with strict medical necessity criteria: genetic confirmation of APDS (PIK3CD or PIK3R1 mutation), patient age ≥12 years and weight ≥45 kg, and specialist prescriber (immunologist/hematologist). Fastest path: 1)

How to Get Evkeeza (Evinacumab) Approved by Aetna CVS Health in Illinois: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Evkeeza Covered by Aetna CVS Health in Illinois Evkeeza (evinacumab) requires prior authorization from Aetna CVS Health for homozygous familial hypercholesterolemia (HoFH). The fastest path to approval: (1) Confirm HoFH diagnosis with genetic testing or clinical criteria, (2) Document failure of maximum-tolerated statin, ezetimibe, and PCSK9 inhibitor,

How to Get Palynziq (pegvaliase-pqpz) Covered by Humana in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Palynziq Covered by Humana in Illinois Palynziq (pegvaliase-pqpz) requires prior authorization from Humana in Illinois. To get approved: (1) Confirm your PKU diagnosis with blood phenylalanine levels >600 µmol/L, (2) Complete REMS program enrollment for both prescriber and patient, (3) Submit Humana's prior

How to Get Soliris (Eculizumab) Covered by Humana in Illinois: Complete 2025 Guide

Answer Box: Getting Soliris Covered by Humana in Illinois Yes, Humana covers Soliris (eculizumab) in Illinois with strict prior authorization requirements. You'll need FDA-approved diagnostic confirmation, meningococcal vaccination proof, and comprehensive clinical documentation. The fastest path: 1) Confirm your diagnosis with required lab tests, 2) Get vaccinated at

How to Get Vimizim (Elosulfase Alfa) Covered by Aetna in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Vimizim Covered by Aetna in Illinois Eligibility: Aetna covers Vimizim (elosulfase alfa) only for confirmed MPS IVA (Morquio A syndrome) with enzyme deficiency or genetic testing. Fastest path: Submit diagnostic proof (GALNS enzyme activity results or genetic test) plus clinical notes via Aetna's Availity portal

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

Quick Answer: Cerezyme requires prior authorization from Aetna CVS Health and is subject to step therapy (Elelyso preferred first). To get coverage: 1) Confirm Gaucher disease diagnosis with enzyme/genetic testing, 2) Document Elelyso trial/failure or contraindication, 3) Submit PA via provider portal with specialist support. If denied, Illinois

Work With Your Doctor to Get Lumizyme (Alglucosidase Alfa) Approved by Blue Cross Blue Shield in Illinois

Quick Answer: To get Lumizyme (alglucosidase alfa) covered by Blue Cross Blue Shield in Illinois, you'll need prior authorization with documented Pompe disease diagnosis (enzyme assay + genetic testing), specialist involvement (neurologist/cardiologist/pulmonologist), and a detailed medical necessity letter. Start by gathering your diagnostic labs and scheduling a