Topic

Illinois

A collection of 429 issues

Renewing Cerezyme (Imiglucerase) Approval with Blue Cross Blue Shield in Illinois: Complete Guide to Annual Reauthorization

Answer Box: Renewing Your Cerezyme Coverage in Illinois Blue Cross Blue Shield of Illinois (BCBSIL) requires annual reauthorization for Cerezyme (imiglucerase). Start the renewal process 30-45 days before your current authorization expires. You'll need updated clinical documentation showing continued medical necessity, current lab values, and treatment response data.

How to Get Onpattro (Patisiran) Covered by UnitedHealthcare in Illinois: Complete Guide with Appeals Process

Quick Answer: Getting Onpattro Covered by UnitedHealthcare in Illinois Yes, UnitedHealthcare covers Onpattro (patisiran) in Illinois with prior authorization for hereditary transthyretin-mediated amyloidosis polyneuropathy (hATTR-PN). The fastest path: (1) Ensure genetic testing confirms pathogenic TTR variant, (2) Get neurologist evaluation with staging (PND ≤IIIb or FAP Stage 1-2), (3) Submit

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by Aetna CVS Health in Illinois: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Mepsevii Covered by Aetna CVS Health in Illinois Mepsevii (vestronidase alfa-vjbk) requires prior authorization from Aetna CVS Health. You'll need confirmed MPS VII diagnosis via enzyme assay or genetic testing, plus specialist documentation. Illinois law provides strong appeal protections: 15 business days for internal appeals,

How to Get Idelvion Covered by Blue Cross Blue Shield of Illinois: Complete Guide with Forms, Appeals, and Timelines

Quick Answer: Getting Idelvion Covered by Blue Cross Blue Shield Illinois Yes, Idelvion (albutrepenonacog alfa) is covered by Blue Cross Blue Shield of Illinois (BCBSIL) for hemophilia B, but requires prior authorization. Your fastest path: Have your hematologist submit a PA request with factor IX deficiency confirmation (≤2% activity), negative

How to Get Helixate Covered by UnitedHealthcare in Illinois: Coverage Criteria, Appeals, and Approval Strategies

Answer Box: Getting Helixate Covered by UnitedHealthcare in Illinois Important Update: Helixate (including Helixate NexGen) has been discontinued by the manufacturer. UnitedHealthcare no longer covers these products as they're unavailable. Immediate action needed: Work with your hematologist to transition to alternative Factor VIII products like Kovaltry, Advate, or

How to Get Dojolvi (Triheptanoin) Covered by Blue Cross Blue Shield in Illinois: Complete PA and Appeal Guide

Answer Box: Getting Dojolvi Covered by BCBS Illinois Blue Cross Blue Shield Illinois requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD. The fastest path: (1) Gather genetic test results showing pathogenic variants in CPT2, ACADVL, HADHA, or HADHB genes, (2) Have a metabolic specialist complete the PA

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Xywav Covered in Illinois UnitedHealthcare requires prior authorization for Xywav with step therapy requirements. Your fastest path: 1) Enroll in the mandatory REMS program, 2) Document failed trials with preferred alternatives like Xyrem, 3) Submit complete OptumRx prior authorization form with sleep study results and ICD-10 codes

Resources to Get Vimizim (Elosulfase Alfa) Approved by Blue Cross Blue Shield of Illinois: Forms, Portals & Appeal Process

Quick Start: Getting Vimizim Covered by BCBS Illinois Vimizim (elosulfase alfa) requires prior authorization from Blue Cross Blue Shield of Illinois for MPS IVA (Morquio A syndrome). You'll need confirmed GALNS enzyme deficiency or genetic testing, clinical documentation, and submission through BCBS provider portals or BioMarin RareConnections enrollment.

How to Get Natpara (Parathyroid Hormone) Covered by Aetna CVS Health in Illinois: Complete 2025 Guide

Quick Answer: Getting Natpara Covered by Aetna CVS Health in Illinois Important Update: Takeda discontinued Natpara manufacturing globally at the end of 2024, with U.S. Special Use Program shipments ending December 31, 2025. New starts are typically denied due to lack of commercial supply. Only existing patients enrolled in

How to Get Humate-P Covered by UnitedHealthcare in Illinois: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Humate-P Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Humate-P (antihemophilic factor/von Willebrand factor complex) and typically enforces step therapy requiring trial of desmopressin (DDAVP) first, unless contraindicated. If denied, you have 30 days for internal appeals and up to 4 months for Illinois