Summary
UnitedHealthcare Community Plan of Tennessee updated its Ilaris (canakinumab) medical benefit drug policy in its November 2026 bulletin. For Still's disease, including adult-onset Still's disease and systemic juvenile idiopathic arthritis, coverage now requires that the patient not be receiving Ilaris in combination with another systemic targeted immunomodulator for the same indication.
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What to do
Action · 2 steps
01By 2026-12-01: Billing team and providers should review Still's disease (AOSD and SJIA) Ilaris cases for Tennessee Community Plan members and confirm that no patient is receiving Ilaris together with another systemic targeted immunomodulator for the same indication before the Ilaris request or claim is submitted.
02Update prior auth intake and clinical documentation checklists in the prior auth tracker so staff capture current immunomodulator use, and tell providers and front desk staff about the combination restriction.
Original notice
Ilaris ® (Canakinumab)
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →Ilaris® (Canakinumab)LowEffective Dec 1, 2026 · Medical 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 Benefit Drug PolicyBrowse every UnitedHealthcare change in the policy list