Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1111 issues

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&
6 min read

How to Get Orladeyo (berotralstat) Covered by Blue Cross Blue Shield in Washington: Prior Authorization, Appeals, and Cost Assistance Guide

Answer Box: Getting Orladeyo Covered by Blue Cross Blue Shield in Washington Orladeyo (berotralstat) requires prior authorization from Blue Cross Blue Shield plans in Washington, with coverage typically requiring confirmed HAE diagnosis, age ≥12 years, and prophylaxis indication. Your fastest path to approval: 1. Gather documentation: HAE diagnosis with C1-INH/
5 min read

Getting Adynovate (Antihemophilic Factor VIII) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Adynovate Coverage Adynovate (antihemophilic factor VIII, pegylated) requires prior authorization from Blue Cross Blue Shield in New Jersey. Submit PA through your plan's Medical Injectables Program with hemophilia A diagnosis, factor levels, bleeding history, and prophylaxis rationale. If denied, you have 180 days
6 min read

Renewing Sumavel DosePro (Sumatriptan Injection, Needle-Free) Approval with Blue Cross Blue Shield in North Carolina: Annual Requirements & Timeline

Answer Box: Renewing Your Sumavel DosePro Authorization Blue Cross Blue Shield of North Carolina typically requires annual prior authorization renewal for Sumavel DosePro (sumatriptan injection, needle-free). Start the renewal process 60-90 days before your current approval expires to avoid coverage gaps. You'll need updated clinical documentation showing continued
7 min read

How to Get Humate-P Covered by Blue Cross Blue Shield in Washington: Complete Guide to Prior Authorization, Appeals, and Home Infusion

Answer Box: Humate-P (antihemophilic factor/vWF complex) requires prior authorization from Blue Cross Blue Shield plans in Washington, including Premera and Regence. First step: Have your hematologist submit a PA request with VWD subtype documentation, DDAVP trial results, and weight-based dosing calculations through your plan's provider portal. Standard
6 min read

The Requirements Checklist to Get Strimvelis (Autologous CD34+ ADA-SCID Gene Therapy) Covered by Blue Cross Blue Shield in Pennsylvania

Answer Box: Fast Track to Approval Getting Strimvelis (autologous CD34+ ADA-SCID gene therapy) covered by Blue Cross Blue Shield in Pennsylvania requires prior authorization via medical exception due to non-FDA approval and international treatment location (SR-TIGET, Milan). Success depends on: (1) confirmed ADA-SCID diagnosis with biallelic ADA mutations and enzyme
6 min read

How to Get Kymriah (tisagenlecleucel) Covered by Blue Cross Blue Shield of North Carolina: Complete Guide with Forms, Deadlines & Appeal Scripts

Answer Box: Getting Kymriah Covered by Blue Cross NC Blue Cross Blue Shield of North Carolina requires prior authorization for Kymriah (tisagenlecleucel) CAR-T therapy. Your fastest path: Submit via Availity portal with CD19-positive pathology, prior therapy documentation, and treatment at a certified CAR-T center. Appeals success rate is high when
6 min read

How to Get Gilenya (fingolimod) Covered by Blue Cross Blue Shield in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gilenya (fingolimod) Covered by Blue Cross Blue Shield in Ohio Fastest path to approval: Submit a comprehensive prior authorization through your BCBS Ohio provider portal including: 1) Complete prior MS therapy history with failure documentation, 2) Required safety tests (EKG, ophthalmologic exam, labs), and 3) First-dose monitoring
6 min read

How to Get Soliris (Eculizumab) Covered by Blue Cross Blue Shield of Michigan: Complete Guide with Forms, Timelines, and Appeal Scripts

Answer Box: Getting Soliris Covered by BCBS Michigan To get Soliris (eculizumab) covered by Blue Cross Blue Shield of Michigan, you'll need prior authorization through their NovoLogix system. Since July 2024, BCBS Michigan requires patients to try Empaveli (pegcetacoplan) first for most indications unless contraindicated. The fastest path:
7 min read

How to Get Daybue (trofinetide) Covered by Blue Cross Blue Shield California: Forms, Appeals, and State Protections

Answer Box: Getting Daybue Covered in California Blue Shield of California requires prior authorization for Daybue (trofinetide) with specific clinical criteria: confirmed Rett syndrome with MECP2 mutation, age ≥2 years, and neurologist prescriber. Initial approval covers 3 months, renewals require evidence of clinical benefit. If denied, California's Independent
6 min read