Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1090 issues

How to Get Voydeya (Danicopan) Covered by Blue Cross Blue Shield in Ohio: Decision Tree & Appeals Guide

Answer Box: Quick Coverage Path Voydeya (danicopan) requires prior authorization from Blue Cross Blue Shield plans in Ohio. To qualify, you need: (1) confirmed PNH by flow cytometry, (2) current treatment with a C5 inhibitor (Soliris/Ultomiris), (3) documented extravascular hemolysis despite C5 therapy, and (4) up-to-date vaccinations. First step

How to Renew Ocrevus (Ocrelizumab) Coverage with Blue Cross Blue Shield of Illinois: Timeline, Evidence, and Appeal Options

Answer Box: Renewing Your Ocrevus Coverage in Illinois Blue Cross Blue Shield of Illinois (BCBSIL) requires periodic reauthorization for Ocrevus (ocrelizumab), typically every 6-12 months. Start renewal 4-6 weeks early with updated MRI, lab results, and neurologist documentation of clinical benefit. Submit via your provider's portal or BCBSIL&

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

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

Myths vs. Facts: Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Blue Cross Blue Shield in Michigan

Answer Box: Getting Hemgenix Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Hemgenix and mandates trying Beqvez first for most commercial members as of November 2024. Submit medical drug PA through OncoHealth via Availity, including hemophilia B diagnosis, failed prophylaxis history, and Beqvez trial documentation.

Myths vs. Facts: Getting Onpattro (patisiran) Covered by Blue Cross Blue Shield in California

Answer Box: Onpattro Coverage with Blue Shield California Getting Onpattro (patisiran) covered by Blue Shield of California requires prior authorization with genetic TTR mutation proof, neurologist evaluation, and ICD-10 code E85.1 documentation. Submit via AuthAccel portal with clinical records showing hATTR polyneuropathy and functional status. If denied, file internal

How to Get Hetlioz LQ (Tasimelteon) Covered by Blue Cross Blue Shield in Illinois: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Hetlioz LQ Covered by Blue Cross Blue Shield in Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) for Smith-Magenis syndrome in children ages 3-15. The fastest path to approval: (1) Confirm your child's SMS diagnosis with genetic

How to Get Xospata (Gilteritinib) Covered by Blue Cross Blue Shield in Illinois: Complete PA Guide & Appeal Process

Answer Box: Getting Xospata Covered by BCBS Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Xospata (gilteritinib), typically placing it in non-preferred specialty tiers with quantity limits. Success requires documented FLT3-mutated relapsed/refractory AML, prior therapy failures, and prescriber attestation. Your first step: Have your hematologist/oncologist

How to Get Takhzyro (lanadelumab-flyo) Covered by Blue Cross Blue Shield California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Takhzyro Covered by Blue Cross Blue Shield California Blue Cross Blue Shield California requires prior authorization for Takhzyro (lanadelumab-flyo) for hereditary angioedema (HAE). To get approved: (1) Your doctor submits a PA request with HAE diagnosis confirmation (low C4/C1-INH labs), attack frequency logs, and failed step

The Complete Requirements Checklist to Get Sylvant (siltuximab) Covered by Blue Cross Blue Shield in Virginia

Answer Box: Getting Sylvant Covered by Blue Cross Blue Shield in Virginia Fastest Path to Approval: Anthem Blue Cross Blue Shield Virginia requires prior authorization for Sylvant (siltuximab) under clinical criteria CC-0113. You must prove HIV-negative and HHV-8-negative multicentric Castleman disease with supporting pathology and lab results. Submit through Anthem&