UnitedHealthcareMedicaid · Coverage · Medical Policy · IN · Rheumatology, Pharmacy, PediatricsMedium impact
Ilaris ® (Canakinumab)
Effective date
Dec 1, 2026
Identified
Nov 7, 2026
Summary
Effective 2026-12-01, UnitedHealthcare's Community Plan Medicaid medical policy for Ilaris (canakinumab) drops the prior exclusion for Indiana and adds a rule that members with active Still's disease, including adult-onset Still's disease (AOSD) and systemic juvenile idiopathic arthritis (SJIA), must not be receiving Ilaris together with another systemic targeted immunomodulator for the same indication. Billing staff should confirm that Indiana Medicaid claims for Ilaris for these indications are now processed under this policy and check that prior auth and documentation for these members reflect that no concurrent systemic targeted immunomodulator is being used for the same indication.
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01By 2026-12-01: Billing team should confirm Indiana Medicaid members with Still's disease (AOSD or SJIA) receiving Ilaris are covered under the updated policy, and update prior auth tracking in the prior auth tracker so the file reflects that the member is not receiving another systemic targeted immunomodulator for the same indication.
02Providers and front desk staff should be told that Ilaris requests for these indications will need documentation of no concurrent systemic targeted immunomodulator use before scheduling or billing; document this in the chart and attach it to the claim or prior auth request.
03Claims for these members without that documentation are likely to be denied under the policy.
Original notice
Ilaris ® (Canakinumab)
uhcprovider.com · Always check the source before changing claims.
Summaries are AI-assisted. Always confirm against the original payer notice.
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