Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 595 issues

How Long Does It Take to Get Galafold (migalastat) Approved by Blue Cross Blue Shield in New Jersey? Complete Timeline & Appeal Guide

Answer Box: Getting Galafold Approved by Blue Cross Blue Shield in New Jersey Galafold (migalastat) requires prior authorization from Horizon Blue Cross Blue Shield of New Jersey, with approval typically taking 5-15 calendar days for standard requests and 24-72 hours for expedited cases. Success depends on documenting an amenable GLA

Get Chenodal (chenodiol) Covered by Blue Cross Blue Shield in Pennsylvania: ICD-10, NDC, and Billing Guide

Answer Box: Getting Chenodal Covered in Pennsylvania Chenodal (chenodiol) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania, including Highmark and Independence Blue Cross. Step 1: Ensure proper ICD-10 coding (K80.20 for radiolucent gallstones). Step 2: Submit PA with imaging proof of radiolucent stones, surgical ineligibility

Getting Orkambi (Lumacaftor/Ivacaftor) Covered by Blue Cross Blue Shield in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Orkambi Coverage in California Orkambi (lumacaftor/ivacaftor) requires prior authorization from Blue Cross Blue Shield of California for patients with cystic fibrosis who are F508del homozygous. Success requires three key elements: genetic testing documentation, specialist prescription, and proper ICD-10 coding (E84.0-E84.9). If denied,

How to Get Amondys 45 (casimersen) Covered by Blue Cross Blue Shield in New Jersey: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Amondys 45 (casimersen) Covered by Blue Cross Blue Shield in New Jersey Amondys 45 requires prior authorization from all Blue Cross Blue Shield plans in New Jersey. To get approval, you need genetic confirmation of an exon 45-skippable DMD mutation, evaluation by a neurologist, and baseline kidney

How to Get Takhzyro (lanadelumab-flyo) Covered by Blue Cross Blue Shield of Michigan: Complete Appeals Guide

Answer Box: Getting Takhzyro Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Takhzyro (lanadelumab-flyo) with specific criteria: confirmed HAE diagnosis (low C4/C1-INH), documented attack history, and trial/failure of alternatives like Haegarda or Orladeyo. Your fastest path: Have your allergist/immunologist submit the

How to Get Thiola / Thiola EC (tiopronin) Covered by Blue Cross Blue Shield of Michigan: Complete Timeline, Appeals, and Documentation Guide

Answer Box: Getting Thiola/Thiola EC Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Thiola/Thiola EC (tiopronin). The fastest path to approval: (1) Have your urologist/nephrologist submit PA request with 24-hour urine cystine >500 mg/day and documented failure of conservative

Lowering Out-of-Pocket for Sylvant (Siltuximab) with Blue Cross Blue Shield in Michigan: Copay Cards, Appeals & Financial Assistance

Answer Box: Getting Sylvant (Siltuximab) Covered by Blue Cross Blue Shield in Michigan Blue Cross Blue Shield of Michigan (BCBSM) requires prior authorization for Sylvant and covers it under the medical benefit only. The fastest path to approval: (1) Ensure your doctor documents HIV-negative and HHV-8-negative status with idiopathic multicentric

Renewing Myozyme Coverage with Blue Cross Blue Shield of Michigan: 2025 Requirements and Timeline

Answer Box: Myozyme Renewal Essentials Myozyme (alglucosidase alfa) prior authorization with Blue Cross Blue Shield of Michigan typically expires annually and requires updated clinical documentation to demonstrate ongoing medical necessity. Start your renewal 60-90 days before expiration to avoid treatment gaps. Your specialist must submit the current BCBSM medical drug

How to Get Krystexxa (Pegloticase) Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Krystexxa Approved by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Krystexxa (pegloticase) with specific clinical criteria: documented refractory gout, failed trials of allopurinol and febuxostat, persistent serum uric acid ≥6 mg/dL, and normal G6PD testing. Submit through the Availity Authorization portal

Getting Pombiliti Covered by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals & Financial Assistance Guide

Answer Box: How to Get Pombiliti Covered by Blue Cross Blue Shield of Texas Pombiliti (cipaglucosidase alfa-atga) is not on the 2024 BCBS Texas formulary, requiring a prior authorization or formulary exception. Your fastest path to coverage: (1) Have your specialist submit a detailed prior authorization request with documented Pompe