Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 593 issues

How to Get Jakafi (Ruxolitinib) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Answer Box: Jakafi (ruxolitinib) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. Your doctor must document your diagnosis (myelofibrosis or polycythemia vera), prove hydroxyurea failure or intolerance, and submit clinical notes through your plan's PA portal. If denied, Pennsylvania's new external review

How to Get Photrexa (Riboflavin) Covered by Blue Cross Blue Shield in Texas: Prior Authorization Guide

Quick Answer: Getting Photrexa Covered by BCBS Texas Blue Cross Blue Shield of Texas (BCBSTX) covers Photrexa (riboflavin ophthalmic solution) with the iLink system for progressive keratoconus when prior authorization requirements are met. You'll need documented disease progression (Kmax increase ≥1.0 diopter), corneal thickness ≥400 microns, and

How to Get Opsumit (Macitentan) Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Opsumit Covered by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Opsumit (macitentan). Your doctor must submit a PA request through the BCBS provider portal or Availity, documenting your PAH diagnosis and any failed prior treatments. If denied, you have 180 days to

How to Get Myozyme (Alglucosidase Alfa) Covered by Blue Cross Blue Shield in New York: Appeals Guide and State Protections

Answer Box: Getting Myozyme Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield in New York requires prior authorization for Myozyme (alglucosidase alfa) with confirmed Pompe disease diagnosis and specialist involvement. The fastest path to approval: (1) Ensure your metabolic/genetic specialist has documented enzyme deficiency

How to Get Hetlioz LQ (tasimelteon oral suspension) Approved by Blue Cross Blue Shield of Georgia: Timeline, Forms, and Appeal Strategy

Answer Box: Getting Hetlioz LQ Approved by Blue Cross Blue Shield of Georgia Fastest path to approval: Submit complete prior authorization through Anthem's provider portal with genetic testing confirming Smith-Magenis syndrome, sleep disorder documentation, and medical necessity letter. Standard review takes 5-7 business days; urgent cases get 72-hour

How to Get Duopa Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Duopa Covered by Blue Cross Blue Shield in New Jersey Duopa requires prior authorization from Blue Cross Blue Shield in New Jersey under the medical benefit (not pharmacy). Submit through your neurologist with documented advanced Parkinson's disease, ≥2-3 hours daily "OFF" time, failed

How Long Does It Take to Get Rezlidhia (olutasidenib) Approved by Blue Cross Blue Shield in Georgia? Complete Timeline and Appeal Process

Answer Box: Getting Rezlidhia Covered by Blue Cross Blue Shield in Georgia Blue Cross Blue Shield Georgia requires prior authorization for Rezlidhia (olutasidenib) with decisions within 72 hours for standard requests and 24 hours for urgent oncology cases. Key requirements include documented IDH1 mutation testing, hematologist/oncologist prescriber, and relapsed/

Lowering Out-of-Pocket for Dojolvi (Triheptanoin) with Blue Cross Blue Shield in North Carolina: Copay, Tiering & Assistance

Answer Box: Getting Dojolvi Covered by Blue Cross Blue Shield in North Carolina Fastest path to approval: Submit prior authorization through your prescriber with molecular confirmation of LC-FAOD, detailed medical necessity letter, and documentation of failed alternatives. Blue Cross NC requires PA for Dojolvi (Tier 5 specialty). If denied, appeal

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

Quick Answer: Getting Takhzyro Covered by Blue Cross Blue Shield in Washington To get Takhzyro (lanadelumab-flyo) approved by Blue Cross Blue Shield in Washington, you need: (1) confirmed HAE Type I or II diagnosis with C1-INH and C4 lab results, (2) documentation of failed or contraindicated alternatives like Haegarda or

How to Get Takhzyro (Lanadelumab) Covered by Blue Cross Blue Shield North Carolina: Complete Timeline & Appeals Guide

Answer Box: Getting Takhzyro Covered by BCBS North Carolina Blue Cross Blue Shield North Carolina requires prior authorization for Takhzyro (lanadelumab) with decisions typically made within 3 business days. For hereditary angioedema patients, approval depends on confirmed HAE Type I/II diagnosis, documented attack frequency (≥1 attack every 4 weeks)