Topic

Illinois

A collection of 430 issues

How to Get Photrexa (Riboflavin) Covered by Humana in Illinois: Coding, Appeals & Prior Authorization Guide

Answer Box: Getting Photrexa Covered by Humana in Illinois Photrexa (riboflavin ophthalmic solution) requires prior authorization from Humana for corneal collagen cross-linking in progressive keratoconus or corneal ectasia. The fastest path to approval: 1) Use correct codes (ICD-10 H18.62x for unstable keratoconus, HCPCS J2787 x2 units, CPT 0402T), 2)

How to Get Gattex (teduglutide) Covered by Blue Cross Blue Shield of Illinois: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Gattex Approved in Illinois To get Gattex (teduglutide) covered by Blue Cross Blue Shield of Illinois, you need prior authorization showing short bowel syndrome with parenteral nutrition dependence. Submit clinical documentation including PN logs, specialist attestation, and failed alternative therapies. If denied, you have 60 days to

How to Get Strensiq (asfotase alfa) Covered by Cigna in Illinois: Decision Tree, Appeals, and Next Steps

Answer Box: Your Path to Strensiq Coverage in Illinois Cigna requires strict prior authorization for Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia (HPP). You qualify if you have documented perinatal, infantile, or juvenile-onset HPP with low alkaline phosphatase and genetic confirmation. Next steps: (1) Gather diagnostic proof including ALPL mutation testing,

How to Get Skyrizi (risankizumab) Covered by Aetna CVS Health in Illinois: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Skyrizi (risankizumab) Covered To get Skyrizi covered by Aetna CVS Health in Illinois: Your doctor must submit a prior authorization showing you meet medical necessity criteria—typically moderate-to-severe disease and documented failure or intolerance to at least one TNF inhibitor (like Humira). The process takes 30-45 days

How to Get Naglazyme (Galsulfase) Covered by Blue Cross Blue Shield in Illinois: Prior Authorization, Appeals, and State Rights

Answer Box: Your Fastest Path to Approval Getting Naglazyme (galsulfase) covered by Blue Cross Blue Shield of Illinois requires prior authorization with confirmed MPS VI diagnosis and specialist oversight. Illinois law prohibits step therapy for formulary drugs (effective January 2025), but standard PA still applies. If denied, you have 60

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Blue Cross Blue Shield in Illinois: Complete Guide with Forms and Appeal Scripts

Answer Box: To get Upstaza (eladocagene exuparvovec) covered by Blue Cross Blue Shield of Illinois, you need: (1) confirmed AADC deficiency diagnosis with genetic testing, (2) prior authorization through the BCBSIL specialty drug portal, and (3) documentation from a certified gene therapy center. Start by gathering genetic test results and

Renewing Givlaari (givosiran) Approval with Cigna in Illinois: Complete Guide to Documentation, Timelines, and Appeals

Quick Answer: Givlaari (givosiran) renewal with Cigna requires annual documentation showing reduced attack frequency, ongoing specialist care, and absence of serious toxicity. Submit renewal requests 2-4 weeks before your current approval expires. If denied, you have 180 days for internal appeals and 30 days for Illinois external review. Start gathering

How to Get Myozyme (alglucosidase alfa) Covered by Blue Cross Blue Shield of Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Myozyme Covered by BCBS Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Myozyme (alglucosidase alfa) for Pompe disease treatment. The fastest path to approval involves three key steps: (1) Submit complete diagnostic documentation including GAA enzyme assay and genetic testing results, (2) Have your

How to Get Humate-P Covered by Cigna in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Approval Humate-P requires prior authorization from Cigna in Illinois. Submit the Hemophilia Factor VIII Prior Authorization Form through CoverMyMeds or fax to Accredo at 855-840-1678. Include: diagnosis confirmation, von Willebrand disease subtype documentation, and proof of desmopressin trial/failure (unless contraindicated for your VWD type)

How to Get Adynovate (Antihemophilic Factor) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Adynovate Covered by Aetna CVS Health in Illinois Adynovate requires prior authorization from Aetna CVS Health in Illinois. Submit requests through the Availity portal with complete hemophilia A documentation including Factor VIII activity levels, bleeding history, and medical necessity justification. If denied, you have 180 days to