Summary
UnitedHealthcare Community Plan of New Mexico's November 2026 Medicaid medical policy update revises the Ilaris (canakinumab) coverage rationale for Active Still's Disease, including adult-onset Still's disease (AOSD) and systemic juvenile idiopathic arthritis (SJIA), to state that members must not be receiving Ilaris in combination with another systemic targeted immunomodulator for the same indication. Billing staff should confirm that claims for these members reflect whether a concurrent systemic targeted immunomodulator is being given for the same indication.
Get alerts when payers change rules like this one
We check UnitedHealthcare and other payers every day and email you when a change matches your specialty and state.
Get UnitedHealthcare alertsPolicy Monitoring is free. No card required.
What to do
Action · 1 steps
01By 2026-12-01: Billing team and rheumatology providers should review Ilaris orders for members with AOSD or SJIA and confirm no other systemic targeted immunomodulator is being prescribed for the same indication, documenting this in the chart before claims are submitted; update prior authorization requests and charge entry notes accordingly.
Original notice
Ilaris® (Canakinumab)
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →Ilaris ® (Canakinumab)MediumEffective Dec 1, 2026 · Medical Benefit Drug PolicyIlaris ® (Canakinumab)LowEffective Dec 1, 2026 · Medical Benefit Drug PolicyIlaris ® (Canakinumab)MediumEffective Dec 1, 2026 · Medical Benefit Drug PolicyIlaris ® (Canakinumab)MediumEffective Dec 1, 2026 · Medical PolicyBrowse every UnitedHealthcare change in the policy list