Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1118 issues

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

How to Get Kalydeco (ivacaftor) Covered by Blue Cross Blue Shield in Georgia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Kalydeco Covered by Blue Cross Blue Shield in Georgia Blue Cross Blue Shield (Anthem) in Georgia covers Kalydeco (ivacaftor) for cystic fibrosis patients with FDA-approved responsive CFTR mutations, but requires prior authorization through their specialty pharmacy network. The fastest path: Have your CF specialist submit a prior

How to Get Zolgensma (Onasemnogene Abeparvovec) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered in New York Blue Cross Blue Shield plans in New York cover Zolgensma (onasemnogene abeparvovec) for spinal muscular atrophy when strict medical necessity criteria are met. First step: Call your BCBS member services to confirm your specific plan's gene therapy policy and prior

How to Get Opfolda (miglustat) Covered by Blue Cross Blue Shield North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Opfolda Covered by Blue Cross Blue Shield NC Opfolda (miglustat) requires prior authorization from Blue Cross Blue Shield North Carolina and must be used with Pombiliti for adult LOPD patients ≥40 kg who haven't improved on standard ERT for ≥1 year. First step today: Call

How to Get Somatuline Depot (lanreotide) Covered by Blue Cross Blue Shield in Ohio: Prior Authorization Forms, Appeals, and Timeline Guide

Answer Box: Getting Somatuline Depot Covered in Ohio Blue Cross Blue Shield (BCBS) plans in Ohio typically require prior authorization for Somatuline Depot (lanreotide) with specific criteria for acromegaly, GEP-NETs, and carcinoid syndrome. Most plans limit coverage to one syringe per 28 days (maximum 120 mg every 4 weeks) and

Getting Filsuvez (Birch Triterpenes Topical Gel) Covered by Blue Cross Blue Shield in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Filsuvez Covered by Blue Cross Blue Shield in Georgia Eligibility: Filsuvez requires prior authorization for junctional or dystrophic epidermolysis bullosa patients ≥6 months with open wounds ≥21 days old. Fastest path: Submit complete PA with genetic confirmation, specialist attestation, and documented failed standard wound care. First step

How to Get Tegsedi (Inotersen) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Tegsedi Covered by Blue Cross Blue Shield in New Jersey Tegsedi (inotersen) requires prior authorization from Blue Cross Blue Shield plans in New Jersey, typically as a non-preferred specialty drug. To get coverage: (1) Your neurologist submits a PA request with hATTR polyneuropathy diagnosis, genetic testing, and

Blue Cross Blue Shield Michigan's Coverage Criteria for Pyrukynd (mitapivat): What Counts as "Medically Necessary"?

Answer Box: Getting Pyrukynd Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Pyrukynd (mitapivat), typically with these three key steps: (1) Confirmed PKLR gene variants proving pyruvate kinase deficiency, (2) Clinical severity documentation (hemoglobin ≤10 g/dL or ≥6 transfusions in 12 months), and (3)