Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1115 issues

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

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

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:

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

Getting Rystiggo (rozanolixizumab-noli) Covered by Blue Cross Blue Shield in New Jersey: Complete Coding, Prior Authorization, and Appeals Guide

Answer Box: Your Path to Rystiggo Coverage in New Jersey Rystiggo (rozanolixizumab-noli) requires prior authorization from Blue Cross Blue Shield in New Jersey for generalized myasthenia gravis patients who are AChR or MuSK antibody positive. First step: Confirm if your plan covers it under medical benefit (J9333 billing) or specialty

How to Get Elevidys Covered by Blue Cross Blue Shield in New York: Prior Authorization, Appeals, and Renewal Guide

Answer Box: Getting Elevidys Covered by Blue Cross Blue Shield in New York Fastest path: Contact your neurologist to submit a prior authorization through your specific BCBS plan's provider portal (Empire, Highmark, or Excellus). Include genetic testing confirming DMD, current ambulatory status, age ≥4 years, baseline liver function

Work With Your Doctor to Get Blenrep (belantamab mafodotin) Covered by Blue Cross Blue Shield in Pennsylvania: Provider Collaboration Guide

Answer Box: Getting Blenrep Covered in Pennsylvania Current Status: Blenrep is withdrawn from the US market until FDA review concludes (October 2025 PDUFA date). Access is limited to GSK's compassionate use program or clinical trials. Fastest Path: Work with your oncologist to apply for GSK's expanded

Denied for Stelara by Blue Cross Blue Shield in North Carolina? Complete Appeals Guide (Forms, Timelines & Scripts)

Answer Box: Getting Stelara Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Stelara (ustekinumab), typically with step therapy requirements. If denied, you have strong appeal rights through North Carolina's Smart NC program. Fastest path: Submit a

Renewing Filspari (Sparsentan) Coverage with Blue Cross Blue Shield in California: Complete 2024 Guide with Timelines and Forms

Answer Box: Renewing Filspari Coverage in California Blue Shield of California requires quarterly renewal documentation for Filspari (sparsentan), including updated proteinuria labs, liver function tests per REMS requirements, and nephrologist attestation of clinical benefit. Start renewal 30-45 days before expiration. Submit via AuthAccel portal with current UPCR, eGFR, and LFTs.

How to Get Cerezyme (Imiglucerase) Covered by Blue Cross Blue Shield in Georgia: Complete Appeals Guide with Forms & Timelines

Answer Box: Getting Cerezyme Covered by Blue Cross Blue Shield in Georgia Blue Cross Blue Shield in Georgia (Anthem) typically covers Cerezyme (imiglucerase) for Type 1 Gaucher disease under the medical benefit with prior authorization. First step: Call the pharmacy member services number on your ID card to confirm coverage