Topic

Illinois

A collection of 421 issues

Humana's Coverage Criteria for Besponsa (Inotuzumab Ozogamicin) in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Besponsa (Inotuzumab Ozogamicin) Covered by Humana in Illinois Humana Medicare Advantage requires prior authorization for Besponsa through their specialty oncology vendor Evolent Health. Medical necessity requires: CD22-positive B-cell precursor ALL, relapsed/refractory status, prior therapy failures documented, and hepatic monitoring plan. Submit PA via Evolent portal or
6 min read

If Cresemba (Isavuconazole) Isn't Approved by Humana in Illinois: Formulary Alternatives & Exception Paths

Answer Box: Quick Guide to Cresemba Alternatives & Exceptions If Humana denies Cresemba (isavuconazole) in Illinois, formulary alternatives typically include voriconazole, posaconazole, and amphotericin B formulations on lower tiers with prior authorization. For exceptions: submit Humana's coverage determination form with medical necessity documentation within 72 hours for standard
5 min read

How to Get Kanuma (Sebelipase Alfa) Covered by Humana in Illinois: Medical Necessity Criteria and Appeals Process

Answer Box: Getting Kanuma Covered by Humana in Illinois Humana requires prior authorization for Kanuma (sebelipase alfa) with strict medical necessity criteria. You need confirmed LAL deficiency diagnosis (enzyme activity test or LIPA gene variants), clinical evidence of disease (elevated liver enzymes, dyslipidemia), and specialist involvement. First step: Have your
5 min read