Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1131 issues

The Requirements Checklist to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield of Texas: Forms, Appeals, and PA Guide

Answer Box: Getting Enhertu Covered by Blue Cross Blue Shield of Texas Eligibility: Patients with HER2-positive or HER2-low breast cancer, HER2-positive gastric cancer, or HER2-mutant NSCLC who meet FDA labeling criteria. Fastest path: Submit prior authorization with complete HER2 testing, medical necessity letter, and ILD monitoring plan through BCBS Texas
6 min read

How to Get Qinlock (ripretinib) Covered by Blue Cross Blue Shield of Michigan: Forms, Appeals, and Prior Authorization Guide

Quick Answer: Getting Qinlock Approved by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Qinlock (ripretinib), typically after documented failure of at least three prior kinase inhibitors including imatinib. Submit requests through the provider portal or OncoHealth OneUM portal for oncology drugs. If denied, you have
6 min read

Work With Your Doctor to Get Bylvay (Odevixibat) Approved by Blue Cross Blue Shield in Pennsylvania: Complete Provider Collaboration Guide

Answer Box: Getting Bylvay Covered in Pennsylvania Bylvay (odevixibat) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. Your fastest path to approval: (1) Ensure your pediatric gastroenterologist or hepatologist confirms PFIC or Alagille syndrome diagnosis with genetic testing, (2) Document failed conventional treatments like bile acid
6 min read

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by Blue Cross Blue Shield in Washington: Complete PA Guide with Forms and Appeals

Answer Box: Getting HyperHEP Covered in Washington Blue Cross Blue Shield plans in Washington require prior authorization for HyperHEP (hepatitis B immune globulin). To get approved: 1) Have your provider submit a PA request through Availity Essentials with exposure documentation and CDC guideline references, 2) Include timing (within 7 days
6 min read

How to Get Elelyso (taliglucerase alfa) Covered by Blue Cross Blue Shield in New York: Complete Guide to Prior Authorization, Appeals, and Medical Necessity

Quick Answer: Getting Elelyso Covered in New York Empire BlueCross BlueShield requires prior authorization for Elelyso (taliglucerase alfa). You'll need confirmed Type 1 Gaucher disease diagnosis (enzyme assay or genetic testing), specialist prescriber, and documented failure/intolerance of preferred ERTs like Cerezyme or VPRIV due to step therapy
5 min read