Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 103 issues

How to Get Gattex (teduglutide) Covered by Blue Cross Blue Shield of Illinois: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Gattex Approved in Illinois To get Gattex (teduglutide) covered by Blue Cross Blue Shield of Illinois, you need prior authorization showing short bowel syndrome with parenteral nutrition dependence. Submit clinical documentation including PN logs, specialist attestation, and failed alternative therapies. If denied, you have 60 days to

Get Arikayce Covered by Blue Cross Blue Shield Michigan: Prior Authorization Forms, Appeals, and State Review Process

Quick Answer: Arikayce requires prior authorization from Blue Cross Blue Shield of Michigan, typically with step therapy requirements. Start by having your doctor submit a PA request with documentation of refractory MAC lung disease and failed standard therapies. If denied, you have 127 days to file an external review with

Do You Qualify for Prolastin-C Coverage by Blue Cross Blue Shield in New York? Decision Tree & Next Steps

Answer Box: Getting Prolastin-C Covered in New York To get Prolastin-C covered by Blue Cross Blue Shield in New York, you need: (1) Confirmed severe alpha-1 antitrypsin deficiency (Pi*ZZ genotype), (2) FEV1 between 30-65% predicted, and (3) clinical evidence of emphysema. First step today: Contact your pulmonologist to order

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by Blue Cross Blue Shield in Virginia: Complete Timeline & Appeal Guide

Quick Answer: Getting Xenpozyme Covered by Blue Cross Blue Shield in Virginia Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Blue Cross Blue Shield Virginia, typically decided within 72 hours for standard requests. To get approved: (1) Ensure you have documented ASMD diagnosis with genetic/enzyme confirmation, (2) Submit complete prior

How to Get Duopa Covered by Blue Cross Blue Shield in Pennsylvania: Appeals Guide with Forms and Timelines

Answer Box: Getting Duopa Covered by Blue Cross Blue Shield in Pennsylvania Duopa requires prior authorization from all Pennsylvania Blue Cross Blue Shield plans in 2024. Success requires documenting advanced Parkinson's disease with motor fluctuations, failed oral therapy trials, and surgical candidacy for PEG-J placement. If denied, Pennsylvania&

How to Get Rinvoq (upadacitinib) Covered by Blue Cross Blue Shield of North Carolina: Prior Authorization Forms, Appeals, and Success Strategies

Answer Box: Getting Rinvoq Covered by BCBS NC Blue Cross Blue Shield of North Carolina requires prior authorization for Rinvoq (upadacitinib) and typically enforces step therapy requirements. Here's your fastest path to approval: 1. Submit PA request using BCBS NC's prior authorization form with documentation of

How to Get Juxtapid (Lomitapide) Covered by Florida Blue Cross Blue Shield: PA Forms, Appeals & Success Tips

Answer Box: Getting Juxtapid Covered by Florida Blue Juxtapid (lomitapide) requires prior authorization from Florida Blue and is typically placed on Tier 6 (Non-Preferred Specialty). To get approval: 1) Your doctor must submit genetic testing confirming homozygous familial hypercholesterolemia (HoFH) with bi-allelic pathogenic variants, 2) Document failed trials of PCSK9

How to Get Natpara Covered by Blue Cross Blue Shield in North Carolina: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Natpara Covered by Blue Cross Blue Shield in North Carolina Important Update: Natpara manufacturing ended December 2024, with the Special Use Program ceasing December 31, 2025. New patient requests are typically denied due to discontinued availability. For existing patients transitioning off Natpara, focus on documenting medical necessity

How to Get Naglazyme (Galsulfase) Covered by Blue Cross Blue Shield in Illinois: Prior Authorization, Appeals, and State Rights

Answer Box: Your Fastest Path to Approval Getting Naglazyme (galsulfase) covered by Blue Cross Blue Shield of Illinois requires prior authorization with confirmed MPS VI diagnosis and specialist oversight. Illinois law prohibits step therapy for formulary drugs (effective January 2025), but standard PA still applies. If denied, you have 60

How to Get Chenodal (Chenodiol) Covered by Blue Cross Blue Shield in New Jersey: Timeline, Forms & Appeal Guide

Answer Box: Getting Chenodal Covered in New Jersey Chenodal (chenodiol) requires prior authorization from Blue Cross Blue Shield in New Jersey. The fastest path to approval: 1) Have your doctor submit a PA request through Horizon's provider portal with imaging confirming radiolucent gallstones and documentation of surgical ineligibility,