Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1130 issues

How to Get Gilenya (Fingolimod) Covered by Blue Cross Blue Shield in Virginia: Complete PA Guide with Forms and Appeals

Answer Box: Fast Track to Gilenya Coverage in Virginia Getting Gilenya (fingolimod) covered by Blue Cross Blue Shield in Virginia requires prior authorization in most cases. Your fastest path: 1) Verify your plan's formulary status through Anthem's provider portal, 2) Have your neurologist submit a complete

Myths vs. Facts: Getting Zokinvy (lonafarnib) Covered by Blue Cross Blue Shield in Virginia

Answer Box: Zokinvy Coverage in Virginia Getting Zokinvy (lonafarnib) covered by Blue Cross Blue Shield in Virginia requires genetic confirmation of HGPS, specialist prescription, and prior authorization. The fastest path: Have a geneticist or pediatric cardiologist submit complete documentation including genetic test results, BSA calculation (≥0.39 m²), and medical

How to Get Crysvita (Burosumab) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Crysvita Covered in Washington Yes, Blue Cross Blue Shield covers Crysvita (burosumab) in Washington with prior authorization. The fastest path: 1) Have your endocrinologist submit PA with genetic testing, biochemical labs (serum phosphate, FGF23), and step therapy documentation, 2) If denied, file internal appeal within 180 days,

How to Get Kanuma (Sebelipase Alfa) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Kanuma Covered by Blue Cross Blue Shield in California Kanuma (sebelipase alfa) requires prior authorization from Blue Cross Blue Shield plans in California. To secure approval: (1) Confirm LAL-D diagnosis with enzyme activity testing and genetic confirmation, (2) Document hepatic abnormalities and lipid profile showing disease severity,

Oxbryta (Voxelotor) Coverage After FDA Withdrawal: What New York Patients Need to Know About Blue Cross Blue Shield Transitions

Answer Box: Oxbryta Coverage Status in New York Oxbryta (voxelotor) is no longer FDA-approved as of September 2024 due to safety concerns. Blue Cross Blue Shield plans in New York now deny claims for this discontinued medication. If you were taking Oxbryta, immediately contact your healthcare provider to discuss alternative

How to Get Tavalisse (Fostamatinib) Covered by Blue Cross Blue Shield in California: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Tavalisse Covered by Blue Cross Blue Shield in California Tavalisse (fostamatinib) is covered by Blue Shield of California as a specialty medication requiring prior authorization and specialty pharmacy dispensing. The fastest path to approval: 1) Have your hematologist submit a prior authorization request documenting failed first-line ITP

Blue Cross Blue Shield Ohio's Coverage Criteria for Signifor LAR (Pasireotide): What Counts as "Medically Necessary"?

Answer Box: Getting Signifor LAR Covered in Ohio Blue Cross Blue Shield Ohio requires prior authorization for Signifor LAR (pasireotide). To qualify, you need: (1) endocrinologist prescription, (2) documented Cushing's disease with elevated UFC levels OR acromegaly with failed first-generation somatostatin analogs, and (3) evidence that surgery isn&

How to Get Tremfya (Guselkumab) Covered by Blue Cross Blue Shield in Ohio: Complete 2024 Guide with Forms and Appeals

Answer Box: Getting Tremfya Covered in Ohio Blue Cross Blue Shield Ohio requires prior authorization for Tremfya (guselkumab) with step therapy requirements. You'll need PASI score ≥10, documented failure of preferred biologics like Humira, and TB screening within 12 months. Submit through CVS Caremark Specialty at (866) 752-7021.

How Long Does It Take to Get Keytruda (Pembrolizumab) Approved by Blue Cross Blue Shield in New York? Complete Timeline Guide

Answer Box: Keytruda Approval Timeline in New York Getting Keytruda (pembrolizumab) approved by Blue Cross Blue Shield in New York typically takes 15 business days for standard prior authorization, or 72 hours for expedited reviews when medically urgent. Your oncologist must submit biomarker test results (PD-L1, MSI-H, or TMB-H as

Abecma (Idecabtagene Vicleucel) Approval with Blue Cross Blue Shield in New Jersey: Complete Coverage Guide

Answer Box: Getting Abecma Covered in New Jersey Eligibility: Adults with relapsed/refractory multiple myeloma after ≥2 prior lines including an IMiD, proteasome inhibitor, and anti-CD38 antibody. Fastest path: Your oncologist submits prior authorization to Horizon Blue Cross Blue Shield through Prime Therapeutics, including complete treatment history and medical necessity