Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1134 issues

How to Get Mycapssa (octreotide, oral) Covered by Blue Cross Blue Shield in Virginia: Prior Authorization Forms, Appeals Timeline, and Step Therapy Rights

Answer Box: Getting Mycapssa Covered in Virginia Blue Cross Blue Shield Virginia (Anthem) requires prior authorization for Mycapssa (oral octreotide) with step therapy requirements. You must document prior treatment with injectable octreotide or lanreotide before approval. Submit requests through the Anthem provider portal with complete clinical documentation. Standard approval takes

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

Answer Box: Getting Trikafta Covered in New Jersey Trikafta requires prior authorization from Horizon Blue Cross Blue Shield of New Jersey. Your CF specialist must submit genetic documentation proving F508del mutation, complete clinical justification, and use Horizon's specialty pharmacy network. If denied, New Jersey's IHCAP external

How to Get StrataGraft Covered by Blue Cross Blue Shield in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting StrataGraft Covered by BCBS Ohio StrataGraft requires prior authorization from Blue Cross Blue Shield Ohio for adults with deep partial-thickness thermal burns when surgical intervention is clinically indicated. The fastest path to approval: (1) Ensure patient meets FDA criteria—adults with intact dermal elements, (2) Submit comprehensive

The Requirements Checklist to Get Chenodal (Chenodiol) Covered by Blue Cross Blue Shield in Virginia

Answer Box: Your Path to Chenodal Coverage Getting Chenodal (chenodiol) covered by Blue Cross Blue Shield in Virginia requires prior authorization with specific clinical documentation. You'll need proof of radiolucent gallstones, surgical contraindications, and failed ursodiol therapy (unless contraindicated). Submit through your provider using Anthem's PA

How to Get Waylivra (Volanesorsen) Covered by Blue Cross Blue Shield Texas: Prior Authorization Guide, Appeals Process, and State Protections

Answer Box: Getting Waylivra Covered in Texas Waylivra (volanesorsen) requires formulary exception and prior authorization from Blue Cross Blue Shield of Texas since it's not FDA-approved in the US. For familial chylomicronemia syndrome (FCS), you'll need confirmed diagnosis, documented failure of standard triglyceride therapies, and specialist

Getting Kanuma (Sebelipase Alfa) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Cost-Saving Guide

Answer Box: Getting Kanuma Covered in Pennsylvania Kanuma (sebelipase alfa) is typically covered by Blue Cross Blue Shield plans in Pennsylvania as a specialty drug requiring prior authorization. To get coverage: 1. Submit PA request with LAL-D diagnosis confirmation (enzyme activity test + LIPA genetic testing) 2. Use specialty pharmacy (required

Work With Your Doctor to Get HyperHEP (Hepatitis B Immune Globulin) Approved by Blue Cross Blue Shield in Pennsylvania

Answer Box: Getting HyperHEP Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield Pennsylvania (Highmark and Independence) requires prior authorization for HyperHEP (hepatitis B immune globulin). Your fastest path to approval: work with your doctor to submit a complete prior authorization request documenting post-exposure prophylaxis need within

How Long Does It Take to Get Cresemba (Isavuconazole) Approved by Blue Cross Blue Shield in Pennsylvania? Complete Timeline & Appeals Guide

Answer Box: Quick Start Guide Getting Cresemba (isavuconazole) approved by Blue Cross Blue Shield in Pennsylvania typically takes 5-15 business days for standard prior authorization, or 72 hours for expedited urgent requests. Your fastest path: Have your infectious disease specialist submit a complete prior authorization through the BCBS provider portal

Work With Your Doctor to Get Somatuline Depot (Lanreotide) Approved by Blue Cross Blue Shield in Michigan: Forms, Appeals, and Success Strategies

Answer Box: Getting Somatuline Depot Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Somatuline Depot (lanreotide). Approval depends on FDA-approved diagnosis (acromegaly, neuroendocrine tumors, carcinoid syndrome), documented failure of octreotide, and complete clinical documentation. First step: Have your endocrinologist or oncologist gather your treatment history

Oxbryta (Voxelotor) Coverage by Blue Cross Blue Shield in Illinois: 2024 FDA Withdrawal Impact and Alternative Options

Answer Box: Oxbryta Coverage Status in Illinois Oxbryta (voxelotor) was withdrawn from the US market by FDA in September 2024 due to safety concerns. Blue Cross Blue Shield of Illinois and all insurers now automatically deny coverage as the drug is no longer FDA-approved. No appeals or bridge coverage are