Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1131 issues

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

Myths vs. Facts: Getting Ocrevus (ocrelizumab) Covered by Blue Cross Blue Shield in Washington

Answer Box: Getting Ocrevus Covered by Blue Cross Blue Shield in Washington Eligibility: Ocrevus requires prior authorization from Blue Cross Blue Shield Washington plans. New requests effective March 10, 2025 require failure of 2+ disease-modifying therapies including natalizumab for relapsing MS, or confirmed primary progressive MS diagnosis under age 55.

How to Get Givlaari (givosiran) Covered by Blue Cross Blue Shield in Virginia: Complete Appeals Guide

Answer Box: Getting Givlaari Covered in Virginia Fastest path to approval: Ensure your specialist documents at least 2 acute hepatic porphyria attacks in the past 6 months with elevated ALA/PBG levels, submit prior authorization through the BCBS Virginia provider portal with complete attack history and genetic testing results, and

Myths vs. Facts: Getting Filspari (Sparsentan) Covered by Blue Cross Blue Shield of Michigan in 2025

Quick Answer: Blue Cross Blue Shield of Michigan covers Filspari (sparsentan) with mandatory prior authorization. Success requires: confirmed IgA nephropathy biopsy, proteinuria ≥0.5 g/day, eGFR ≥30, 12 weeks of optimized ACE/ARB therapy, and nephrologist involvement. Submit complete documentation upfront to avoid delays. If denied, Michigan's

Renewing Approval for Gilenya (Fingolimod) with Blue Cross Blue Shield in New York: Complete Guide to Timeline, Documentation, and Appeals

Quick Answer: Gilenya Renewal with Blue Cross Blue Shield in New York Renewal Timeline: Start 60-90 days before current authorization expires. Required Documentation: Updated medical necessity letter, current monitoring results (EKG, eye exam, liver function), and treatment response data. First Step Today: Contact your neurologist's office to schedule

How to Get Ofev (Nintedanib) Covered by Blue Cross Blue Shield in Texas: Prior Authorization Guide and Appeal Process

Answer Box: Getting Ofev Covered by Blue Cross Blue Shield in Texas Ofev (nintedanib) is covered on Blue Cross Blue Shield of Texas formularies but requires prior authorization for idiopathic pulmonary fibrosis and related conditions. To get approval: (1) Have your pulmonologist submit a PA request with HRCT results, pulmonary

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Blue Cross Blue Shield Illinois: Complete PA Guide with ICD-10 Codes and Appeals

Answer Box: Getting Vyndaqel/Vyndamax Covered in Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Vyndaqel/Vyndamax (tafamidis) with confirmed ATTR-CM diagnosis, appropriate NYHA class, and AL amyloidosis exclusion. Fastest approval path: Have your cardiologist submit PA with PYP scan results (grade 2-3 uptake) or biopsy, negative

How to Get Brineura (Cerliponase Alfa) Covered by Blue Cross Blue Shield in Ohio: Renewal Guide, Forms & Appeals

Answer Box: Getting Brineura Covered by Blue Cross Blue Shield Ohio Brineura (cerliponase alfa) requires prior authorization from Blue Cross Blue Shield Ohio, typically renewed every 6-12 months. Start your renewal 30-60 days before expiration to avoid treatment gaps. You'll need genetic confirmation of CLN2 disease, CLN2 Clinical

How to Get Ultomiris (Ravulizumab) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Coverage Guide

Answer Box: Getting Ultomiris Covered by Blue Cross Blue Shield in Pennsylvania To get Ultomiris (ravulizumab) covered by Blue Cross Blue Shield in Pennsylvania: 1) Confirm your diagnosis meets FDA criteria (PNH, aHUS, gMG, or NMOSD) with required lab tests, 2) Complete meningococcal vaccination and REMS enrollment, 3) Submit prior

Work With Your Doctor to Get Strensiq (Asfotase Alfa) Approved by Blue Cross Blue Shield in Washington: Complete Provider Collaboration Guide

Answer Box: Your Path to Strensiq Approval in Washington To get Strensiq (asfotase alfa) covered by Blue Cross Blue Shield in Washington, you'll need: (1) documented pediatric-onset hypophosphatasia with genetic/biochemical confirmation, (2) a comprehensive medical necessity letter from your specialist, and (3) baseline ophthalmology and renal imaging.