Topic

Illinois

A collection of 410 issues

Getting Trikafta (elexacaftor/tezacaftor/ivacaftor) Covered by Blue Cross Blue Shield of Illinois: Complete PA Guide and Appeal Process

Answer Box: Getting Trikafta Covered in Illinois Trikafta requires prior authorization (PA) from Blue Cross Blue Shield of Illinois for cystic fibrosis patients aged ≥2 years with qualifying CFTR mutations. Submit genetic testing confirming F508del or eligible mutations, pulmonologist prescription, and CF diagnosis (ICD-10 E84.0-E84.9) via BCBSIL PA

How to Get Arikayce (Amikacin Liposome Inhalation) Covered by Cigna in Illinois: Complete Prior Authorization and Appeal Guide

Answer Box: Fast Track to Arikayce Coverage Cigna requires prior authorization for Arikayce (amikacin liposome inhalation) through Accredo specialty pharmacy. To get approved in Illinois: (1) Your pulmonologist or infectious disease specialist submits PA documentation showing ≥6 months of failed MAC therapy with positive cultures, (2) Request goes through Express

Getting Raxone (Idebenone) Covered by Humana in Illinois: Decision Tree, Appeals Guide, and Medical Necessity Templates

Quick Answer: Can You Get Raxone (Idebenone) Covered by Humana in Illinois? Raxone (idebenone) is not FDA-approved in the US for LHON or any indication, making Humana Medicare Advantage coverage extremely difficult but not impossible. Your best path: (1) Confirm genetic LHON diagnosis with mtDNA testing, (2) Submit a formulary

How to Get Uptravi (Selexipag) Covered by Aetna (CVS Health) in Illinois: Prior Authorization Forms, Appeals Process, and Approval Timeline

Answer Box: Getting Uptravi (Selexipag) Covered by Aetna (CVS Health) in Illinois Yes, Aetna (CVS Health) covers Uptravi (selexipag) for WHO Group I pulmonary arterial hypertension with prior authorization. The fastest path: gather your right heart catheterization report, WHO functional class documentation, and 6-minute walk test results. Submit the Illinois-specific

The Requirements Checklist to Get Eloctate (Coagulation Factor VIII) Covered by Humana in Illinois

Answer Box: Getting Eloctate Covered by Humana in Illinois Eloctate requires prior authorization from Humana but is classified as a preferred Factor VIII product with no step therapy requirements. Submit PA via Humana provider portal with hematologist documentation including hemophilia A diagnosis (ICD-10 D66), bleeding history, and weight-based dosing rationale.

How to Get Vanflyta (Quizartinib) Covered by Aetna CVS Health in Illinois: Complete Approval Timeline and Appeals Guide

Answer Box: Getting Vanflyta Covered by Aetna CVS Health in Illinois Vanflyta (quizartinib) requires prior authorization from Aetna CVS Health for FLT3-ITD-positive AML, with approval typically taking 30-45 days for standard review or ≤72 hours if expedited. Key requirements: FLT3-ITD mutation documentation, baseline EKG showing QTc ≤450ms, and hematologist prescription.

How to Get Strimvelis Gene Therapy Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Get Strimvelis Covered by Aetna CVS Health in Illinois Strimvelis gene therapy for ADA-SCID requires prior authorization from Aetna CVS Health with genetic confirmation of biallelic ADA mutations, enzyme activity <1% normal, and documented failures of PEG-ADA therapy. Submit through the Aetna provider portal with a medical

The Complete Checklist to Get Cystadane (betaine anhydrous) Covered by Blue Cross Blue Shield in Illinois: Forms, Appeals, and Approval Strategies

Quick Answer: Getting Cystadane Covered by BCBS Illinois Cystadane (betaine anhydrous) requires prior authorization from Blue Cross Blue Shield of Illinois for all plans. The fastest path to approval: (1) Submit PA through the Carelon Provider Portal with genetic testing confirming homocystinuria (ICD-10 E72.11 or E72.12), elevated homocysteine

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

Answer Box: Getting Defitelio Covered by Aetna in Illinois Defitelio (defibrotide) requires prior authorization from Aetna CVS Health for severe hepatic veno-occlusive disease (VOD/SOS) with organ dysfunction post-HSCT. Submit PA through Aetna provider portal with complete transplant records, organ dysfunction evidence, and FDA indication match. If denied, file internal

How to Get Adynovate (Antihemophilic Factor, PEGylated) Covered by Humana in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Adynovate Covered by Humana in Illinois Adynovate requires prior authorization from Humana Clinical Pharmacy Review (HCPR) for all Medicare Advantage plans in Illinois. The fastest path to approval: (1) Submit PA request with Factor VIII level <5%, bleeding history documentation, and hemophilia A diagnosis confirmation, (2)