Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1130 issues

Getting Besponsa (Inotuzumab Ozogamicin) Covered by Blue Cross Blue Shield in North Carolina: Complete Coding and Appeals Guide

Answer Box: Fast Track to Besponsa Coverage Getting Besponsa covered by Blue Cross Blue Shield in North Carolina requires proper coding and documentation. Use ICD-10 code C91.00-C91.02 for B-cell ALL, HCPCS J9229 for billing, and ensure CD22-positive status is documented. Submit prior authorization through Blue Cross NC'

Get Orfadin (Nitisinone) Covered by Blue Cross Blue Shield in Florida: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Orfadin Covered by Blue Cross Blue Shield in Florida Fastest path to approval: Work with your doctor to submit a prior authorization through Florida Blue's specialty pharmacy network with complete hereditary tyrosinemia type 1 (HT-1) documentation. If denied, file an internal appeal within 180 days,

The Complete Requirements Checklist to Get Spinraza (Nusinersen) Covered by Blue Cross Blue Shield in New York

Answer Box: Your Path to Spinraza Coverage Who qualifies: Patients with genetically confirmed 5q SMA (Types 1-3) who haven't received concurrent SMA therapies like Zolgensma or Evrysdi. Fastest approval path: Submit prior authorization with genetic testing results, baseline motor function scores, and neurologist attestation through your Blue Cross

Getting Trikafta Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Trikafta Covered by Blue Cross Blue Shield NC Eligibility: Patients with cystic fibrosis age 2+ with at least one F508del or responsive CFTR mutation. Fastest path: Have your CF specialist submit prior authorization with genetic testing results, clinical notes showing CF diagnosis, and specialist attestation. Start today:

Myths vs. Facts: Getting Ruconest (C1 Esterase Inhibitor) Covered by Blue Cross Blue Shield in Michigan

Answer Box: Getting Ruconest Covered by BCBS Michigan Eligibility: Ruconest requires prior authorization from Blue Cross Blue Shield of Michigan for acute hereditary angioedema (HAE) attacks only—not prophylaxis. Fastest path: Submit PA with confirmed HAE diagnosis (two separate lab tests showing C1-INH deficiency), attack documentation, and specialist prescription. First

The Requirements Checklist to Get Exondys 51 (Eteplirsen) Covered by Blue Cross Blue Shield in Illinois

Answer Box: Getting Exondys 51 Covered in Illinois Fastest path to approval: Submit prior authorization with genetic testing confirming exon 51-amenable DMD mutation, specialist prescription, and 6-minute walk test results. First step today: Contact your neurologist or neuromuscular specialist to initiate genetic testing if not completed. Blue Cross Blue Shield

How to Get Filsuvez (Birch Triterpenes) Covered by Blue Cross Blue Shield in California: Complete Appeal Guide 2025

Quick Answer: Getting Filsuvez Covered in California Filsuvez (birch triterpenes topical gel) requires prior authorization from Blue Cross Blue Shield in California. For patients with junctional or dystrophic epidermolysis bullosa, the fastest path to approval involves: 1) Having your dermatologist or EB specialist submit a detailed PA request with confirmed

How to Get Koselugo (Selumetinib) Covered by Blue Cross Blue Shield in Georgia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Koselugo Covered by Blue Cross Blue Shield in Georgia Eligibility: Children ≥1 year with confirmed NF1 and symptomatic, inoperable plexiform neurofibromas. Fastest path: Submit prior authorization with baseline LVEF assessment, ophthalmologic evaluation, and specialist attestation through your provider's BCBS portal. First step today: Contact your

Lowering Out-of-Pocket for Vyondys 53 (golodirsen) with Blue Cross Blue Shield in Florida: Copay, Tiering & Assistance

Answer Box: Reducing Vyondys 53 Costs in Florida Vyondys 53 is covered by Florida Blue under medical benefits with 20-40% coinsurance after deductible. To minimize costs: (1) Enroll in SareptAssist patient support at 1-888-727-3782 for copay assistance, (2) Request a tier exception if facing high cost-sharing through Florida Blue'

Getting Cometriq (Cabozantinib) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Prior Authorization and Appeals Guide

Quick Answer: Cometriq requires prior authorization from Blue Cross Blue Shield plans in Pennsylvania. You'll need: (1) diagnosis of metastatic medullary thyroid carcinoma with ICD-10 code C73, (2) prescription from an oncologist, and (3) submission through specialty pharmacy networks only. If denied, you have 180 days for internal