Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 595 issues

Getting Acthar Gel Approved by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Acthar Gel Covered by BCBS Texas Acthar Gel requires prior authorization from Blue Cross Blue Shield of Texas, with approval based on FDA-approved indications and documented failure of corticosteroids. Your fastest path to approval: (1) Have your prescriber submit a detailed PA request through the BCBS provider

How to Get Cimzia (Certolizumab Pegol) Covered by Blue Cross Blue Shield of North Carolina: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Getting Cimzia Covered in North Carolina Cimzia (certolizumab pegol) requires prior authorization from Blue Cross Blue Shield of North Carolina and is subject to step therapy requirements. The fastest path to approval: 1) Submit PA with documented failure of preferred TNF inhibitors, 2) Include TB/HBV screening and

How to Get Hemlibra (Emicizumab-kxwh) Covered by Blue Cross Blue Shield in Georgia: Coding, Appeals, and Timeline Guide

Answer Box: Getting Hemlibra Covered by BCBS in Georgia Blue Cross Blue Shield of Georgia (Anthem) requires prior authorization for Hemlibra (emicizumab-kxwh). Your fastest path to approval: 1) Gather complete hemophilia A documentation including Factor VIII inhibitor status, 2) Submit PA request through Availity or Anthem's provider portal

How to Get Carbaglu (Carglumic Acid) Covered by Blue Cross Blue Shield in California: Prior Authorization, Appeals & Forms

Quick Answer: Getting Carbaglu Covered by Blue Cross Blue Shield in California Carbaglu (carglumic acid) is covered as a specialty drug by Blue Shield of California and Anthem Blue Cross, but requires prior authorization. The fastest path to approval: (1) Have your metabolic specialist submit a prior authorization with genetic

How to Get Arikayce Covered by Blue Cross Blue Shield in Texas: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Arikayce Covered in Texas Arikayce (amikacin liposome inhalation) requires prior authorization from Blue Cross Blue Shield of Texas and typically costs over $100,000 annually. To get coverage: 1. Submit PA request with documentation of 6+ months failed MAC combination therapy 2. Use specialty pharmacy (mail order

How Long Does It Take to Get Haegarda Approved by Blue Cross Blue Shield in California? Timeline & Milestones

Answer Box: Getting Haegarda Approved in California Getting Haegarda (C1-esterase inhibitor, SC) approved by Blue Cross Blue Shield California typically takes 5-15 business days for initial review, plus 1-3 days for pre-submission preparation. The fastest path requires complete HAE diagnosis documentation (C1-INH levels, C4 levels, attack history) submitted through Blue

Tavalisse (Fostamatinib) Coverage with Blue Cross Blue Shield Illinois: Prior Authorization, Appeals, and Patient Assistance Guide

Answer Box: Getting Tavalisse Covered in Illinois Tavalisse (fostamatinib) requires prior authorization from Blue Cross Blue Shield Illinois (BCBSIL) and is subject to step therapy requirements. To get coverage: (1) Your hematologist must document failed first-line ITP therapies like corticosteroids or IVIG, (2) Submit PA via Availity Provider Portal with

How Long Does It Take to Get Taltz (Ixekizumab) Approved by Blue Cross Blue Shield in California? Complete Timeline Guide

Answer Box: Getting Taltz (Ixekizumab) Covered by Blue Cross Blue Shield in California Standard timeline: 15 business days for prior authorization approval after complete submission. Blue Cross Blue Shield California requires specialist consultation, documented diagnosis (moderate-to-severe plaque psoriasis, psoriatic arthritis, or spondyloarthritis), and proof of inadequate response to first-line therapies.

How to Get Opzelura (Ruxolitinib Cream) Covered by Florida Blue Cross Blue Shield: Prior Authorization, Appeals & Cost-Sharing Guide

Answer Box: Getting Opzelura Covered by Florida Blue Opzelura (ruxolitinib cream) requires prior authorization from Florida Blue Cross Blue Shield. Your dermatologist must submit documentation showing failed topical corticosteroids and calcineurin inhibitors for atopic dermatitis or vitiligo. The medication must be dispensed through Accredo or CVS Specialty pharmacies to ensure

How to Get Revcovi (Elapegademase) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Revcovi Covered by BCBS in New Jersey Revcovi (elapegademase) requires prior authorization from Horizon Blue Cross Blue Shield of New Jersey. Your fastest path to approval: (1) Confirm ADA-SCID diagnosis with enzyme/genetic testing, (2) Have your immunologist submit the specialty medication PA form through Horizon'