Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1266 issues

Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Blue Cross Blue Shield in New York: PA Forms, Appeals, and Cost Assistance

Answer Box: Getting Hemgenix Covered by Blue Cross Blue Shield in New York Eligibility: Adults ≥18 with severe hemophilia B (Factor IX ≤2%) on prophylaxis or with serious bleeding history. Fastest Path: Submit prior authorization through your BCBS plan's provider portal with Factor IX levels, bleeding records, and

How to Get Uplizna (Inebilizumab) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Uplizna (Inebilizumab) Covered by Blue Cross Blue Shield in New Jersey Uplizna (inebilizumab) requires prior authorization from Blue Cross Blue Shield for AQP4-positive NMOSD or IgG4-related disease. In New Jersey, your fastest path to approval involves: (1) confirming AQP4-IgG positive test results via cell-based assay, (2) documenting

How Long Does It Take to Get Busulfex (Busulfan Injection) Approved by Blue Cross Blue Shield in New Jersey? Timeline & Appeal Process

Answer Box: Getting Busulfex Approved in New Jersey Blue Cross Blue Shield plans in New Jersey require prior authorization for Busulfex (busulfan injection, HCPCS J0594) used in transplant conditioning regimens. Standard approvals take 9-12 calendar days, while urgent requests for transplant conditioning receive decisions within 24-72 hours. Coverage falls under

How to Get Bavencio (Avelumab) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Bavencio Covered in New Jersey Bavencio (avelumab) requires prior authorization from Blue Cross Blue Shield plans in New Jersey, managed through the Carelon Oncology Program. Submit your PA request with diagnosis confirmation, prior treatment history, and dosing per FDA guidelines. If denied, you have 180 days to

How to Get Photrexa (Riboflavin) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Photrexa 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 Photrexa (riboflavin ophthalmic solution) used in epithelium-off corneal cross-linking for progressive keratoconus. To get approval: (1) Document keratoconus progression with serial

Myths vs. Facts: Getting Joenja (leniolisib) Covered by Blue Cross Blue Shield in Washington

Answer Box: Getting Joenja (leniolisib) Covered by Blue Cross Blue Shield in Washington Fact: Blue Cross Blue Shield plans in Washington (primarily Premera Blue Cross and Regence BlueShield) require prior authorization for Joenja (leniolisib), but approval is achievable with proper documentation. Key requirements: genetic confirmation of APDS (PIK3CD or PIK3R1

Blue Cross Blue Shield Ohio Coverage Criteria for Venclexta (venetoclax): What Counts as "Medically Necessary"?

Answer Box: Getting Venclexta Covered by BCBS Ohio Blue Cross Blue Shield of Ohio (BCBSOH) requires prior authorization for Venclexta (venetoclax) with specific medical necessity criteria. For CLL/SLL: confirmed diagnosis and age ≥18. For AML: age ≥75 or comorbidities preventing intensive chemotherapy, plus combination therapy. First step today: Contact

How to Get Alecensa (alectinib) Covered by Blue Cross Blue Shield in New York: Complete Appeals Guide and Success Strategies

Answer Box: Getting Alecensa (alectinib) Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield of New York requires prior authorization for Alecensa (alectinib) in ALK-positive NSCLC patients. The fastest path to approval: (1) Submit ALK testing confirmation via FDA-approved methods (FISH, IHC, NGS), (2) Include complete

How to Get Isturisa (Osilodrostat) Covered by Blue Cross Blue Shield in Michigan: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Isturisa Approved by Blue Cross Blue Shield in Michigan Isturisa (osilodrostat) requires prior authorization from Blue Cross Blue Shield of Michigan for adult Cushing's disease patients. Your fastest path to approval: 1) Gather documented hypercortisolism via two positive tests (24-hour UFC, late-night salivary cortisol, or

Getting Bavencio (Avelumab) Covered by Blue Cross Blue Shield Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Your Path to Bavencio Coverage in Texas Blue Cross Blue Shield of Texas covers Bavencio (avelumab) with prior authorization for FDA-approved uses: metastatic Merkel cell carcinoma and maintenance urothelial carcinoma. Submit PA requests through Availity Essentials or call the number on your member ID card. If denied, you