Topic

Illinois

A collection of 429 issues

How to Get Opdivo (nivolumab) Covered by Humana Medicare in Illinois: Prior Authorization, Appeals & Coding Guide

Answer Box: Getting Opdivo Covered by Humana in Illinois Opdivo (nivolumab) requires prior authorization from Humana Medicare Advantage plans in Illinois. Your fastest path to approval: 1) Have your oncologist submit a prior authorization request with complete clinical documentation including diagnosis codes, treatment history, and medical necessity justification; 2) Use

How to Get Skyrizi (Risankizumab) Covered by Blue Cross Blue Shield of Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Blue Cross Blue Shield of Illinois requires prior authorization for Skyrizi (risankizumab). Submit the Illinois Uniform PA Form through Prime Therapeutics with documented step therapy attempts. If denied, you have 180 days to appeal internally, then 4 months for Illinois external review. Start by calling the number on

How to Get Opfolda (miglustat) Covered by Cigna in Illinois: Complete PA Guide and Appeal Process

Answer Box: Getting Opfolda Covered by Cigna in Illinois Cigna requires prior authorization for Opfolda (miglustat) in combination with Pombiliti for adults with late-onset Pompe disease. Key requirements: age ≥18, weight >40kg, confirmed LOPD diagnosis, and documented failure to improve after ≥1 year on Lumizyme or Nexviazyme. Fastest path

How to Get Symdeko/Symkevi Covered by UnitedHealthcare in Illinois: Prior Authorization, Appeals & Forms

Answer Box: Getting Symdeko/Symkevi Covered in Illinois UnitedHealthcare covers Symdeko/Symkevi for cystic fibrosis patients age 6+ with eligible CFTR mutations, but requires prior authorization. The fastest path: 1) Confirm your genotype shows homozygous F508del or another responsive mutation, 2) Have your CF specialist submit PA with genetic test

How to Get Tracleer (bosentan) Covered by UnitedHealthcare in Illinois: Complete Guide to Prior Authorization, Appeals, and State Rights

Quick Answer: Getting Tracleer Covered by UnitedHealthcare in Illinois Tracleer (bosentan) requires prior authorization from UnitedHealthcare, REMS program enrollment, and specialist involvement. Start by having your cardiologist, pulmonologist, or rheumatologist submit a prior authorization request through the UnitedHealthcare Provider Portal with documentation of PAH diagnosis, failed alternatives if step therapy

Getting Galafold (migalastat) Covered by Cigna in Illinois: A Complete Prior Authorization Guide

Answer Box: Fastest Path to Galafold Coverage Eligibility: Adults with Fabry disease and a confirmed amenable GLA variant. Required: Genetic test showing amenable mutation, specialist involvement (geneticist/metabolic specialist), and prior authorization through Express Scripts/Accredo. First step today: Gather genetic test results and contact your prescriber to initiate the

How to Get Keytruda (pembrolizumab) Covered by Aetna in Illinois: Complete Coverage Guide with Appeals Process

Answer Box: Getting Keytruda Covered by Aetna in Illinois Fastest path to approval: Aetna requires precertification for Keytruda with specific biomarker documentation (PD-L1 CPS, MSI-H, or TMB-H depending on cancer type). Submit the Aetna precertification form with complete clinical notes, pathology reports, and prior treatment history. If denied, Illinois offers

Getting Raxone (Idebenone) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Start Guide Raxone (idebenone) is excluded from Aetna CVS Health's 2024 formularies, requiring a medical exception request for LHON coverage. Fastest path: Submit the Medical Exception/Prior Authorization form with genetic testing results, ophthalmologic documentation, and medical necessity letter. If denied, Illinois residents have 30

How to Get Mavenclad (Cladribine) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Mavenclad Approved by UnitedHealthcare in Illinois Mavenclad requires prior authorization from UnitedHealthcare through OptumRx. You'll need confirmed relapsing MS diagnosis (ICD-10: G35), documentation of failed trials with at least two other MS therapies, normal lymphocyte counts, and submission by a neurologist or MS specialist. Start

Renewing Vyndaqel/Vyndamax (Tafamidis) Approval with Aetna CVS Health in Illinois: Annual Requirements and Timeline

Answer Box: Renewing Your Tafamidis Approval in Illinois Aetna CVS Health requires annual reauthorization for tafamidis (Vyndaqel/Vyndamax), typically 30-60 days before your current approval expires. Start early: gather updated clinical documentation showing treatment response (echocardiogram, NT-proBNP levels, functional status). Submit renewal through your prescriber via Aetna's provider