Topic

Illinois

A collection of 425 issues

How to Get Defitelio (Defibrotide) Covered by Humana in Illinois: PA Requirements, Appeals, and Cost Assistance

Quick Answer: Defitelio (defibrotide) requires prior authorization from Humana Medicare Advantage plans in Illinois for its FDA-approved use treating hepatic veno-occlusive disease (VOD/SOS) after stem cell transplantation. Your prescriber must submit documentation proving organ dysfunction and medical necessity. If denied, you have 65 days to appeal and can request
5 min read

Work With Your Doctor to Get Chenodal (Chenodiol) Covered by Humana in Illinois: Provider Partnership Guide

Answer Box: Getting Chenodal (Chenodiol) Covered by Humana in Illinois Chenodal (chenodiol) requires prior authorization from Humana for radiolucent gallstone dissolution or cerebrotendinous xanthomatosis (CTX). Success depends on strong provider partnership: gather imaging confirming radiolucent stones, document surgical contraindications, and ensure baseline liver function tests are normal. Your provider must
6 min read

Work With Your Doctor to Get Elelyso (taliglucerase alfa) Covered by Cigna in Illinois: Complete Provider Collaboration Guide

Answer Box: Fast Track to Elelyso (taliglucerase alfa) Coverage To get Elelyso (taliglucerase alfa) covered by Cigna in Illinois, you'll need prior authorization with confirmed Type 1 Gaucher disease diagnosis, specialist prescriber, and documentation of failed or contraindicated preferred ERTs (Cerezyme, VPRIV). Your doctor submits via CoverMyMeds or
6 min read

UnitedHealthcare's Coverage Criteria for Poteligeo (mogamulizumab-kpkc) in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Poteligeo Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Poteligeo (mogamulizumab-kpkc) with documented mycosis fungoides/Sézary syndrome, failure of ≥1 prior systemic therapy, and prescriber specialty (oncology/dermatology). Fastest path to approval: 1. Gather complete TNMB staging documentation and prior therapy records 2. Submit PA
6 min read

How to Get Crysvita (Burosumab) Covered by Humana in Illinois: Appeal Templates and Approval Guide

Quick Answer: Getting Crysvita (Burosumab) Approved by Humana in Illinois Prior authorization is required. Humana requires genetic confirmation of X-linked hypophosphatemia (XLH) or documented tumor-induced osteomalacia (TIO), evidence of failed conventional therapy, and specialist oversight. If denied, you have 65 days to appeal internally, then 4 months for Illinois external
4 min read

Getting Cimzia (Certolizumab Pegol) Covered by UnitedHealthcare in Illinois: Prior Authorization, Appeals & Forms

Quick Answer: Getting Cimzia Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Cimzia (certolizumab pegol) in Illinois. You'll need documentation of diagnosis (Crohn's, RA, etc.), tuberculosis/hepatitis B screening, and evidence of failed first-line treatments. Submit through the UnitedHealthcare provider portal with complete clinical
5 min read