Topic

Illinois

A collection of 426 issues

If Tegsedi (Inotersen) Isn't Approved by Blue Cross Blue Shield in Illinois: Formulary Alternatives & Exception Paths

Answer Box: Your Options When BCBS Illinois Denies Tegsedi If Blue Cross Blue Shield of Illinois denies Tegsedi (inotersen) for hATTR polyneuropathy, you have three main paths: try covered alternatives like patisiran (Onpattro), file a formulary exception with strong clinical justification, or pursue an internal appeal followed by external review

How to Get Blenrep (belantamab mafodotin) Covered by Aetna in Illinois: Complete Timeline & Appeals Guide

Answer Box: Getting Blenrep Covered by Aetna in Illinois Blenrep (belantamab mafodotin) received FDA approval on October 23, 2025 for relapsed/refractory multiple myeloma. For Aetna coverage in Illinois: 1. Check eligibility: Must have relapsed/refractory multiple myeloma after ≥2 prior therapies including a proteasome inhibitor and immunomodulatory agent 2.

How to Get Ocrevus (ocrelizumab) Covered by Humana in Illinois: Prior Authorization, Appeals & Step Therapy

Answer Box: Getting Ocrevus Covered by Humana in Illinois Ocrevus (ocrelizumab) requires prior authorization from Humana and is subject to step therapy requirements. You'll typically need to document failure or intolerance of preferred DMTs first. The medication is covered under Part B (medical benefit), not Part D. First

How to Get Jakafi (Ruxolitinib) Covered by Blue Cross Blue Shield in Illinois: Complete Appeals Guide with Forms and Timelines

Quick Answer: Your Path to Jakafi Coverage Blue Cross Blue Shield of Illinois requires prior authorization for Jakafi (ruxolitinib). You're likely eligible if you have confirmed myelofibrosis (intermediate/high-risk), polycythemia vera with hydroxyurea failure/intolerance, or steroid-refractory GVHD. The fastest path: Have your oncologist submit the PA form

How to Get Kanuma (Sebelipase Alfa) Covered by Cigna in Illinois: Coding, Appeals, and Authorization Guide

Answer Box: Getting Kanuma Covered by Cigna in Illinois Kanuma (sebelipase alfa) requires prior authorization from Cigna in Illinois. The fastest path: 1) Submit PA request with LAL-D diagnosis (ICD-10: E75.5), genetic/enzyme test results, and clinical documentation to Cigna via fax (855-840-1678) or CoverMyMeds. 2) Use HCPCS code

Blue Cross Blue Shield Illinois Coverage for Firazyr (Icatibant): Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Firazyr Covered by BCBS Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Firazyr (icatibant injection) for hereditary angioedema (HAE). Coverage requires confirmed HAE diagnosis with lab evidence (low C4, abnormal C1-INH levels), documented self-administration training, and typically limits coverage to 6 syringes per 30

Renewing Brensocatib (BRINSUPRI) Approval with Humana in Illinois: Documentation, Timelines & Appeal Options

Quick Answer: Renewing Your Brensocatib (BRINSUPRI) Coverage Humana Medicare plans in Illinois require annual prior authorization renewal for Brensocatib (BRINSUPRI). Start your renewal 60-90 days before your current authorization expires. You'll need updated clinical documentation showing reduced exacerbation rates, maintained lung function, and safety monitoring records. Submit through

Getting Strimvelis Gene Therapy Covered by Humana in Illinois: Complete Timeline, Appeals Process, and Medical Tourism Requirements

Answer Box: Getting Strimvelis Covered by Humana in Illinois Strimvelis (ADA-SCID gene therapy) requires exceptional circumstances approval from Humana since it's not FDA-approved in the U.S. and only available in Milan, Italy. Timeline: 30-90 days for initial review, plus appeals if denied. First step: Contact Humana at

How to Get Kanuma (sebelipase alfa) Covered by Aetna (CVS Health) in Illinois: Complete Guide with Forms, Timelines, and Appeal Scripts

Answer Box: Getting Kanuma Covered by Aetna in Illinois Yes, Aetna (CVS Health) covers Kanuma (sebelipase alfa) in Illinois, but requires prior authorization. The fastest path: (1) Submit PA request via Availity provider portal with LAL enzyme deficiency test results and LIPA gene mutation confirmation, (2) Include documentation of hepatic/

Myths vs. Facts: Getting Soliris (Eculizumab) Covered by Blue Cross Blue Shield in Illinois

Answer Box: Getting Soliris Covered in Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Soliris (eculizumab) with documented diagnosis, meningococcal vaccination proof, and clinical justification. If denied, you have strong appeal rights under Illinois law, including automatic external review by independent specialists. Success rates improve dramatically with