Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1083 issues

How Long Does It Take to Get Cometriq (Cabozantinib) Approved by Blue Cross Blue Shield in Georgia? Complete Timeline Guide

Answer Box: Getting Cometriq Approved in Georgia Blue Cross Blue Shield of Georgia (Anthem) typically processes Cometriq (cabozantinib) prior authorization requests within 7-15 business days for standard cases and 72 hours for urgent situations. The fastest path involves submitting a complete PA through an in-network specialty pharmacy with comprehensive medical
5 min read

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield in Pennsylvania: Appeals Guide and Forms

Answer Box: Getting Enhertu Covered by Blue Cross Blue Shield in Pennsylvania Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. Submit HER2 testing results, prior therapy failure documentation, and medical necessity letter via your BCBS provider portal or PA fax line. If denied,
5 min read

The Requirements Checklist to Get Brineura (Cerliponase Alfa) Covered by Blue Cross Blue Shield in Texas

Answer Box: Getting Brineura Covered in Texas Blue Cross Blue Shield of Texas requires prior authorization for Brineura (cerliponase alfa) with strict clinical criteria including confirmed CLN2 diagnosis, specialized neurologist prescription, and documented ambulatory function. Submit via their medical PA portal with genetic/enzyme testing, baseline CLN2 scores, and medical
5 min read

How to Get Jynarque (Tolvaptan) Covered by Blue Cross Blue Shield of Michigan: Complete Guide to Prior Authorization, Appeals, and Medical Necessity

Answer Box: Getting Jynarque Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Jynarque (tolvaptan) with strict criteria: confirmed ADPKD diagnosis, Mayo Class 1C-1E rapid progression, eGFR ≥25 mL/min/1.73m², and REMS enrollment. First step today: Have your nephrologist obtain the BCBSM Jynarque PA
5 min read

How to Get Tagrisso (osimertinib) Covered by Blue Cross Blue Shield in California: Prior Authorization Forms, Appeal Process & Success Strategies

Answer Box: Getting Tagrisso Covered in California Blue Cross Blue Shield plans in California require prior authorization for Tagrisso (osimertinib) with documented EGFR mutations in NSCLC. Submit electronically via CoverMyMeds or the plan's provider portal with pathology reports showing EGFR testing results. If denied, file an internal appeal
6 min read