Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 106 issues

Get Arcalyst (Rilonacept) Covered by Blue Cross Blue Shield in New York: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Arcalyst Covered in New York Yes, Blue Cross Blue Shield plans in New York cover Arcalyst (rilonacept) for approved conditions—but prior authorization is required. The fastest path: Have your specialist submit a PA request with complete documentation of your diagnosis (CAPS, DIRA, or recurrent pericarditis), prior

How to Get Eylea and Lucentis Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization Guide

Quick Answer: Getting Eylea/Lucentis Approved by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Eylea (aflibercept) and Lucentis (ranibizumab). Most plans require step therapy with bevacizumab (Avastin) first, unless contraindicated. Submit requests through Availity Essentials with OCT imaging, visual acuity records, and diagnosis documentation. Standard

How to Get Carbaglu (Carglumic Acid) Covered by Blue Cross Blue Shield of North Carolina: Appeals Guide and State Protections

Answer Box: Getting Carbaglu Covered in North Carolina Carbaglu (carglumic acid) requires prior authorization from Blue Cross Blue Shield of North Carolina for confirmed NAGS deficiency. The fastest path to approval: 1. Submit complete PA request with genetic/biochemical confirmation of NAGS deficiency and elevated plasma ammonia levels 2. Include

Do You Qualify for Photrexa Coverage by Blue Cross Blue Shield in Illinois? Decision Tree & Next Steps

Answer Box: Your Fast Track to Photrexa Coverage You likely qualify for Photrexa coverage if: You have progressive keratoconus or post-refractive corneal ectasia with documented progression (Kmax increase ≥1.0D or pachymetry decrease ≥10-20 microns over 6-12 months). First step today: Have your eye doctor submit prior authorization through BCBS

How to Get Trikafta Covered by Florida Blue Cross Blue Shield: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by Florida Blue Florida Blue requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) with documented CFTR genotype testing. To get approval: (1) Confirm your genetic mutation is FDA-approved for Trikafta, (2) Have your CF specialist submit a prior authorization form with baseline labs and clinical

Do You Qualify for Mepsevii Coverage by Blue Cross Blue Shield in Illinois? Decision Tree & Appeal Guide

Answer Box: Getting Mepsevii Covered by BCBS Illinois Yes, you can get Mepsevii (vestronidase alfa-vjbk) covered by Blue Cross Blue Shield of Illinois if you have a confirmed MPS VII diagnosis. The fastest path: 1) Gather enzyme deficiency test results and genetic confirmation, 2) Have your specialist submit a prior

The Complete Guide to Getting Revcovi (Elapegademase) Covered by Blue Cross Blue Shield in New York: Forms, Appeals, and Success Strategies

Answer Box: Getting Revcovi Covered in New York Blue Cross Blue Shield plans in New York require prior authorization for Revcovi (elapegademase) to treat ADA-SCID. Fastest path to approval: Confirm your ADA-SCID diagnosis with genetic testing or enzyme activity <1% of normal, ensure prescription from an immunologist/specialist, and

How Long Does It Take to Get Soliris (Eculizumab) Approved by Blue Cross Blue Shield in New York? Complete Timeline & Appeal Guide

Answer Box: Getting Soliris (Eculizumab) Covered by Blue Cross Blue Shield in New York Standard approval timeline: 1-5 days for complete submissions through Blue Cross Blue Shield's electronic portal. Key requirements include FDA-approved diagnosis documentation, meningococcal vaccination records, and REMS enrollment proof. Start today: Gather vaccination records and

How to Get Enbrel (Etanercept) Covered by Blue Cross Blue Shield in Ohio: Complete Requirements Guide

Answer Box: Getting Enbrel Covered by Blue Cross Blue Shield in Ohio Blue Cross Blue Shield in Ohio requires prior authorization for Enbrel (etanercept), typically mandating step therapy with biosimilar alternatives first. To get approval: 1) Complete the PA form with detailed clinical documentation showing failed trials of conventional DMARDs

Myths vs. Facts: Getting Enbrel (Etanercept) Covered by Blue Cross Blue Shield in North Carolina

Answer Box: Getting Enbrel Covered by Blue Cross Blue Shield in North Carolina Eligibility: Blue Cross Blue Shield of North Carolina covers Enbrel (etanercept) with prior authorization for FDA-approved conditions like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Step therapy required - you must try biosimilar alternatives first unless contraindicated.