Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1063 issues

Work With Your Rheumatologist to Get Krystexxa (Pegloticase) Approved by Blue Cross Blue Shield in New York: Complete Provider Partnership Guide

Answer Box: Getting Krystexxa Approved by Blue Cross Blue Shield in New York Eligibility: Adults with chronic refractory gout who've failed allopurinol and febuxostat at maximum doses, with persistent uric acid ≥6 mg/dL and ongoing flares or tophi. Fastest path: Work with your rheumatologist to submit prior

Kuvan (Sapropterin) Coverage with Blue Cross Blue Shield Michigan: Complete Prior Authorization and Appeals Guide 2025

Quick Answer: Getting Kuvan Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Kuvan (sapropterin dihydrochloride) with Tier 2 specialty drug status. You'll need a metabolic geneticist's prescription, documented PKU diagnosis, proof of ≥20% phenylalanine reduction after trial, and active phenylalanine-restricted

Getting Trikafta (elexacaftor/tezacaftor/ivacaftor) Covered by Blue Cross Blue Shield of Illinois: Complete PA Guide and Appeal Process

Answer Box: Getting Trikafta Covered in Illinois Trikafta requires prior authorization (PA) from Blue Cross Blue Shield of Illinois for cystic fibrosis patients aged ≥2 years with qualifying CFTR mutations. Submit genetic testing confirming F508del or eligible mutations, pulmonologist prescription, and CF diagnosis (ICD-10 E84.0-E84.9) via BCBSIL PA

How to Get Tavalisse (fostamatinib) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Tavalisse Covered by Blue Cross Blue Shield in Virginia Tavalisse (fostamatinib) requires prior authorization from Blue Cross Blue Shield Virginia and typically needs documented failure of first-line treatments (corticosteroids, IVIG) and TPO receptor agonists (eltrombopag/Promacta, romiplostim/Nplate) for chronic ITP. Submit PA through your hematologist with

Xembify Approval with Blue Cross Blue Shield in Michigan: Answers to the Most Common Questions

Answer Box: Getting Xembify Covered by Blue Cross Blue Shield in Michigan Xembify (immune globulin, SC) requires prior authorization from Blue Cross Blue Shield of Michigan for primary immunodeficiency. Your fastest path to approval: (1) Have your doctor submit a PA request with your PID diagnosis, low IgG labs, and

If Vitrakvi (Larotrectinib) Isn't Approved by Blue Cross Blue Shield of Michigan: Formulary Alternatives & Exception Paths

Answer Box: Quick Path Forward If Blue Cross Blue Shield of Michigan denies Vitrakvi (larotrectinib), you have three main options: try the covered NTRK inhibitor alternative (entrectinib/Rozlytrek if on formulary), request a formulary exception with documented medical necessity, or appeal the denial. Start by checking your specific plan'

Renewing Approval for Jaypirca (Pirtobrutinib) with Blue Cross Blue Shield in California: What to Prepare & When

Answer Box: Renewing Your Jaypirca Coverage Jaypirca (pirtobrutinib) requires annual reauthorization with Blue Cross Blue Shield in California, typically 6-12 months after initial approval. Start the renewal process 30-45 days before your current authorization expires to avoid treatment gaps. Your oncologist must submit updated clinical documentation showing ongoing benefit, tolerability,

How to Get Rapivab (Peramivir) Covered by Blue Cross Blue Shield in New York: Complete Guide to Forms, Appeals, and State Protections

Answer Box: Getting Rapivab Covered in New York Blue Cross Blue Shield (BCBS) plans in New York require prior authorization for Rapivab (peramivir), with strict criteria: acute influenza symptoms ≤48 hours, documented inability to use oral antivirals (Tamiflu, Relenza, Xofluza), and medical necessity justification. Submit through Availity portal or fax

How to Get Evrysdi (risdiplam) Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Evrysdi Approved by Blue Cross Blue Shield in Florida Evrysdi (risdiplam) requires prior authorization from Blue Cross Blue Shield plans in Florida. To get approved: (1) Have your neurologist submit a complete PA request with genetic testing confirming 5q-SMA, baseline motor assessments, and prior therapy history via

Get Pemazyre (Pemigatinib) Covered by Blue Cross Blue Shield in Florida: Complete PA Guide with Forms and Appeals

Answer Box: Quick Path to Pemazyre Coverage in Florida Blue Cross Blue Shield of Florida requires prior authorization for Pemazyre (pemigatinib) based on confirmed FGFR2 fusion/rearrangement testing, prior therapy documentation, and baseline eye exam. Submit PA via Florida Blue provider portal or fax 1-904-348-3295 with genetic test results, pathology