Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1071 issues

How to Get Cimzia (Certolizumab Pegol) Covered by Blue Cross Blue Shield in Georgia: Complete PA Guide with Forms and Appeals

Answer Box: Getting Cimzia Covered by Blue Cross Blue Shield in Georgia Cimzia (certolizumab pegol) requires prior authorization from Blue Cross Blue Shield of Georgia (Anthem) for all commercial plans. To get coverage, you need documented failure of step-therapy requirements (typically other TNF inhibitors like Humira), proper diagnosis codes, and

How to Get Krystexxa (Pegloticase) Covered by Blue Cross Blue Shield in Georgia: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Krystexxa Covered by Blue Cross Blue Shield in Georgia Fastest path to approval: Submit prior authorization through BCBS provider portal with complete documentation of failed xanthine oxidase inhibitor trials (allopurinol/febuxostat), G6PD test results, and rheumatology evaluation. Georgia's step therapy exception law (§33-24-59.25) requires

Lowering Out-of-Pocket for Duopa with Blue Cross Blue Shield in Ohio: Copay Cards, Tiering & Financial Assistance

Answer Box: Duopa Cost Reduction with Blue Cross Blue Shield in Ohio Duopa costs ~$84,000 annually, but Ohio BCBS patients can reduce out-of-pocket through manufacturer copay cards (commercial plans), patient assistance programs (uninsured/underinsured), and specialty tier exceptions. Start with a benefits investigation to determine if Duopa is covered

Resources to Get Eylea and Lucentis Covered by Blue Cross Blue Shield in Florida: Complete Forms, Portals & Appeals Guide

Answer Box: Getting Started To get Eylea (aflibercept) or Lucentis (ranibizumab) covered by Blue Cross Blue Shield in Florida: Submit prior authorization through your ophthalmologist using Florida Blue's Availity portal or CoverMyMeds. Include OCT scans, visual acuity records, and documentation of failed bevacizumab if required by step therapy.

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in North Carolina: Forms, Appeals, and Formulary Alternatives

Answer Box: Getting Epidiolex Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina covers Epidiolex (cannabidiol) as a specialty drug with prior authorization for FDA-approved seizure conditions (Lennox-Gastaut syndrome, Dravet syndrome, tuberous sclerosis complex). First step: Have your neurologist submit a PA request

How to Get Kineret (anakinra) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization Guide

Answer Box: Getting Kineret Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington (Premera Blue Cross and Regence BlueShield) require prior authorization for Kineret (anakinra). Success depends on documenting failed conventional DMARDs for rheumatoid arthritis or confirmed NOMID diagnosis. If denied, Washington's

Getting Rystiggo (Rozanolixizumab-noli) Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization and Appeals Guide

Quick Answer: Blue Cross Blue Shield of Texas doesn't currently list specific prior authorization criteria for Rystiggo (rozanolixizumab-noli), but approval typically requires: positive AChR or MuSK antibodies, MGFA class II-IV generalized myasthenia gravis, MG-ADL score ≥5, failed standard therapies (pyridostigmine, steroids, immunosuppressants), and neurologist prescribing. Start by having

How to Get Xembify (Immune Globulin, SC) Covered by Blue Cross Blue Shield in Texas: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Xembify Covered by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Xembify (immune globulin, SC) with medical necessity criteria including confirmed primary immunodeficiency diagnosis, low IgG levels, and infection history. Your fastest path to approval: (1) Verify if Xembify falls under medical or

How to Get Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization & Appeal Guide

Answer Box: Getting Imbruvica Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington (Premera, Regence) require prior authorization for Imbruvica (ibrutinib) with specific renewal criteria including no disease progression and continued monitoring commitment. Your fastest path to approval: have your oncologist submit urgent PA

Myths vs. Facts: Getting Xyrem (Sodium Oxybate) Covered by Blue Cross Blue Shield in Washington

Answer Box: Getting Xyrem Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington (Premera, Regence/UMP) almost always require prior authorization for Xyrem (sodium oxybate) for narcolepsy. Success depends on complete REMS enrollment, documented narcolepsy diagnosis with sleep studies, and proof of failed stimulant