Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1266 issues

How to Get Jakafi (Ruxolitinib) Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Jakafi Approval in Florida Jakafi (ruxolitinib) requires prior authorization through Florida Blue Cross Blue Shield and is subject to quantity limits (60 tablets per fill). For myelofibrosis, submit PA with confirmed diagnosis, platelet count ≥50,000/mcL, and monitoring plan. For polycythemia vera, add documented

Get Emflaza (Deflazacort) Covered by Blue Cross Blue Shield of Texas: Forms, Appeals & IRO Process

Answer Box: Getting Emflaza Covered by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Emflaza (deflazacort) with specific DMD criteria. Your fastest path: (1) Confirm genetic DMD diagnosis and CK levels ≥10x normal, (2) Document prednisone trial/failure if switching, (3) Submit PA via BCBS Texas

How to Get Venclexta (venetoclax) Covered by Blue Cross Blue Shield in New York: Complete PA Guide and Appeal Process

Quick Answer: Getting Venclexta Covered in New York Blue Cross Blue Shield of New York requires prior authorization for Venclexta (venetoclax), typically with step therapy requirements for BTK inhibitors like ibrutinib in CLL cases. Three-step path: (1) Your oncologist submits PA via Availity Essentials with diagnosis, TLS monitoring plan, and

How to Get Retevmo (Selpercatinib) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Retevmo Covered by Blue Cross Blue Shield in New York Retevmo (selpercatinib) requires prior authorization from Blue Cross Blue Shield in New York for RET fusion-positive NSCLC and RET-mutant thyroid cancers. The fastest path to approval: (1) Confirm RET testing with an FDA-approved companion diagnostic, (2) Submit

How to Get Orfadin (nitisinone) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Orfadin Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield plans in California require prior authorization for Orfadin (nitisinone) as a specialty drug, with coverage limited to confirmed hereditary tyrosinemia type 1 (HT-1) at doses ≤2 mg/kg per day. Your fastest path to

How to Get Vitrakvi (Larotrectinib) Covered by Blue Cross Blue Shield in Ohio: Timeline, Appeals, and NTRK Testing Requirements

Quick Answer: Getting Vitrakvi Covered in Ohio Blue Cross Blue Shield in Ohio typically requires prior authorization for Vitrakvi (larotrectinib), with 15 business days for standard review or 72 hours for expedited cases. Success depends on complete NTRK fusion testing documentation, proof of metastatic/unresectable disease, and evidence of failed

How to Get Blenrep (Belantamab Mafodotin) Covered by Blue Cross Blue Shield in Virginia: Current Access Options and Appeals Guide

Answer Box: Blenrep Coverage in Virginia Blenrep (belantamab mafodotin) is not commercially available in the U.S. as of 2025 due to GSK's voluntary withdrawal in 2022 pending FDA resubmission (PDUFA target October 2025). Current access is limited to clinical trials or expanded access programs only. For Blue

How to Get Dupixent (dupilumab) Covered by Blue Cross Blue Shield in Ohio: Prior Authorization, Appeals, and Step Therapy Override Guide

Answer Box: Getting Dupixent Covered in Ohio Blue Cross Blue Shield (primarily Anthem) in Ohio requires prior authorization for Dupixent (dupilumab) with step therapy requirements varying by indication. Ohio's step therapy override law (ORC §3901.832) requires approval within 72 hours if you've failed preferred treatments

Getting Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in California: Complete Coding, Appeals, and Authorization Guide

Quick Answer: Getting Strimvelis Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield plans in California require prior authorization for Strimvelis (autologous CD34+ gene therapy for ADA-SCID), administered only at SR-TIGET in Milan, Italy. Use ICD-10 code D81.31 (severe combined immunodeficiency due to adenosine deaminase deficiency)

The Requirements Checklist to Get Poteligeo (mogamulizumab-kpkc) Covered by Blue Cross Blue Shield in North Carolina: Forms, Appeals, and Documentation Guide

Answer Box: Fast Track to Poteligeo Coverage To get Poteligeo (mogamulizumab-kpkc) covered by Blue Cross Blue Shield in North Carolina: 1) Confirm your plan requires prior authorization through the Blue Cross NC provider portal, 2) Submit PA with documented relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic