Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 114 issues

How to Get Firazyr (Icatibant) Covered by Blue Cross Blue Shield in Ohio: Complete Guide with Forms and Appeals Process

Quick Answer: Getting Firazyr Covered by BCBS Ohio Blue Cross Blue Shield Ohio requires prior authorization for Firazyr (icatibant) for hereditary angioedema (HAE) treatment. Start today by: 1) Confirming your HAE diagnosis documentation with an immunologist/allergist, 2) Having your doctor submit the PA request through Anthem's provider

Blue Cross Blue Shield North Carolina Coverage Criteria for Jakafi (Ruxolitinib): Complete Prior Authorization Guide

Answer Box: Getting Jakafi Covered by Blue Cross Blue Shield NC Jakafi (ruxolitinib) requires prior authorization from Blue Cross Blue Shield of North Carolina and must be filled at an in-network specialty pharmacy. To get approved: 1. Submit comprehensive PA request with diagnosis documentation (myelofibrosis, polycythemia vera, or GVHD), prior

How to Get Qalsody (Tofersen) Covered by Blue Cross Blue Shield in Illinois: Complete Guide to Prior Authorization, Appeals, and Financial Assistance

Answer Box: Getting Qalsody Covered by Blue Cross Blue Shield in Illinois Qalsody (tofersen) requires prior authorization from Blue Cross Blue Shield of Illinois and is limited to patients with confirmed SOD1 gene mutation causing ALS. The fastest path to approval: (1) Confirm SOD1 mutation with genetic testing results, (2)

Getting Therakos CELLEX Photopheresis Covered by Blue Cross Blue Shield in New Jersey: Prior Authorization, Appeals & Cost Strategies

Answer Box: Quick Path to Coverage Therakos CELLEX photopheresis requires prior authorization from Blue Cross Blue Shield in New Jersey. Your fastest path: 1) Have your specialist submit a comprehensive PA request through Horizon BCBS's provider portal with diagnosis, failed prior treatments, and medical necessity documentation. 2) If

Renewing Hemgenix Coverage with Blue Cross Blue Shield in California: Annual Requirements and Timeline

Answer Box: Blue Shield of California requires annual reauthorization for Hemgenix (etranacogene dezaparvovec) gene therapy. Start renewal 60-90 days before your authorization expires. Submit updated clinical documentation showing ongoing eligibility, Factor IX levels, bleeding episodes, liver function tests, and provider attestation through Blue Shield's AuthAccel portal or designated

How to Get Cabometyx (Cabozantinib) Covered by Blue Cross Blue Shield in North Carolina: Coding, Appeals, and Success Strategies

Quick Answer: Blue Cross Blue Shield of North Carolina requires prior authorization for Cabometyx (cabozantinib) across all plan types as of 2024. Your fastest path to approval: have your oncologist submit a PA request with proper ICD-10 codes (C64 for kidney cancer, C22.0 for liver cancer, C73 for thyroid

How to Get Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in Virginia: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Imbruvica Covered by Blue Cross Blue Shield in Virginia Yes, Imbruvica (ibrutinib) is covered by Blue Cross Blue Shield plans in Virginia, but requires prior authorization. Your doctor must document medical necessity and often prove you've tried preferred BTK inhibitors first. If denied, Virginia'

How to Get Rapivab (Peramivir) Covered by Blue Cross Blue Shield in Florida: Prior Authorization, Appeals, and Approval Strategies

Quick Answer: Getting Rapivab Covered in Florida Rapivab (peramivir) requires prior authorization from Blue Cross Blue Shield of Florida for outpatient use. Your provider must call 1-877-719-2583 or contact Prime Therapeutics at (800) 424-4947 before administration. Key requirements: influenza symptoms ≤48 hours, documented reason why oral antivirals aren't

How to Get Ilaris (Canakinumab) Covered by Blue Cross Blue Shield in Georgia: Complete PA Guide

Answer Box: Getting Ilaris Covered by BCBS Georgia Ilaris (canakinumab) requires prior authorization from Blue Cross Blue Shield in Georgia and is typically placed on specialty tiers (Tier 4-5). The fastest path to approval: 1) Have your doctor submit a complete PA form with medical necessity letter documenting failed alternatives,

Work With Your Doctor to Get Zolgensma Covered by Blue Cross Blue Shield in Florida: Complete Provider Partnership Guide

Answer Box: Your Path to Zolgensma Approval in Florida Getting Zolgensma (onasemnogene abeparvovec) covered by Blue Cross Blue Shield in Florida requires close collaboration with your child's neurologist. Key requirements: child under 2 years old, confirmed bi-allelic SMN1 mutations, genetic testing documentation, and comprehensive clinical records. Fastest path: