Topic

Illinois

A collection of 428 issues

How to Get Abecma (idecabtagene vicleucel) Covered by Humana in Illinois: Complete PA Guide with Forms and Appeal Process

Answer Box: Get Abecma Approved by Humana in Illinois Abecma (idecabtagene vicleucel) requires prior authorization from Humana Medicare Advantage plans in Illinois. Submit a complete PA request with medical records showing triple-class refractory multiple myeloma (IMiD, proteasome inhibitor, anti-CD38 antibody failure), performance status, and organ function. If denied, you have

How to Get Emflaza (Deflazacort) Covered by Blue Cross Blue Shield of Illinois: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Emflaza Covered in Illinois Emflaza (deflazacort) requires prior authorization from Blue Cross Blue Shield of Illinois (BCBSIL) for Duchenne muscular dystrophy (DMD). The fastest path to approval: 1) Ensure proper coding with ICD-10 G71.01 and appropriate HCPCS/NDC codes, 2) Submit complete prior authorization with genetic

How Long Does It Take to Get Oxervate (cenegermin) Approved by UnitedHealthcare in Illinois? Complete Timeline Guide

Answer Box: Getting Oxervate Approved by UnitedHealthcare in Illinois Timeline: 29 seconds to 3 business days for initial approval if all criteria are met. UnitedHealthcare requires stage 2 or 3 neurotrophic keratitis diagnosis and documented failure of at least one over-the-counter artificial tear product. Fastest path: Submit via OptumRx PreCheck

How to Get Koselugo (Selumetinib) Covered by Aetna CVS Health in Illinois: Complete Guide with Forms and Appeals

Answer Box: Getting Koselugo Covered by Aetna CVS Health in Illinois Quick Path to Approval: Koselugo (selumetinib) requires prior authorization from Aetna CVS Health for pediatric NF1 patients. Your fastest route: 1) Have your specialist complete the Illinois Uniform PA Form, 2) Submit with NF1 diagnosis proof and imaging showing

Renewing Prolastin-C Coverage with Cigna in Illinois: 2025 Requirements and Appeal Options

Quick Answer: Renewing Prolastin-C with Cigna in Illinois Cigna requires annual reauthorization for Prolastin-C with specific documentation. Start your renewal 60-90 days before expiration. You'll need updated pulmonary function tests (FEV1 <65% predicted), confirmed AAT levels <11 μM, and specialist involvement. If denied, Illinois law provides

How to Get Blenrep (Belantamab Mafodotin) Covered by Blue Cross Blue Shield of Illinois: Coding, Appeals, and Current Access Options

Answer Box: Blenrep Coverage with Blue Cross Blue Shield of Illinois Current Status: Blenrep (belantamab mafodotin) is not commercially available in the U.S. as of 2025—GSK withdrew it in 2022 pending FDA resubmission (PDUFA date October 2025). Blue Cross Blue Shield of Illinois (BCBSIL) requires prior authorization for

How to Get Tavalisse (Fostamatinib) Covered by UnitedHealthcare in Illinois: Complete Guide with Forms and Appeal Strategies

Answer Box: Getting Tavalisse Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Tavalisse (fostamatinib) in Illinois, with strict step therapy requirements including failed corticosteroids and thrombopoietin receptor agonists. Illinois law prohibits step therapy for state-regulated plans as of 2025, but this doesn't apply to self-insured employer

Myths vs. Facts: Getting Tagrisso (Osimertinib) Covered by Humana in Illinois

Answer Box: Getting Tagrisso (Osimertinib) Covered by Humana in Illinois Humana requires prior authorization for Tagrisso (osimertinib) with documented EGFR mutation testing and FDA-approved indication. If denied, you have 65 days to appeal internally, then 30 days for Illinois external review—one of the strictest deadlines nationally. First step: Have

How to Get Vanflyta (Quizartinib) Covered by Humana in Illinois: Complete PA Guide with Forms and Appeal Process

Answer Box: Getting Vanflyta (Quizartinib) Covered by Humana in Illinois Vanflyta (quizartinib) is not on most Humana formularies, requiring a formulary exception or prior authorization request with extensive clinical documentation. Your fastest path: Have your oncologist submit FLT3-ITD lab results, AML diagnosis documentation, and medical necessity justification through Humana'

How to Get Gattex (Teduglutide) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gattex Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Gattex (teduglutide) with strict medical necessity criteria. You must document short bowel syndrome with parenteral nutrition dependence, complete required diagnostics (colonoscopy for adults), and get specialist attestation. First step today: Gather 12 months of PN logs