Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 595 issues

How to Get Turalio (Pexidartinib) Covered by Blue Cross Blue Shield of Texas: Prior Authorization Guide and Appeal Process

Answer Box: Fastest Path to Approval Turalio (pexidartinib) is covered by Blue Cross Blue Shield of Texas for TGCT but requires prior authorization, REMS enrollment, and specialty pharmacy dispensing. The fastest path: (1) Ensure your prescriber and you complete REMS enrollment at TURALIOREMS.com, (2) Have your provider submit a

How to Get Mycapssa (Octreotide Oral) Covered by Blue Cross Blue Shield Michigan: 2024 Requirements & Appeals Guide

Quick Answer: Getting Mycapssa Covered by BCBS Michigan Mycapssa (oral octreotide) requires prior authorization from Blue Cross Blue Shield of Michigan. To get approved: (1) Confirm your acromegaly diagnosis with ICD-10 code E22.0, (2) document prior response to injectable octreotide or lanreotide, and (3) submit the PA form through

Renewing Mepsevii (vestronidase alfa-vjbk) Approval with Blue Cross Blue Shield in Washington: 2025 Requirements & Timeline

Answer Box: Blue Cross Blue Shield requires annual prior authorization renewal for Mepsevii (vestronidase alfa-vjbk) in Washington, with updated documentation 60-90 days before expiration. Key requirements: confirmed MPS VII diagnosis via enzyme/genetic testing, current specialist prescription, evidence of ongoing clinical benefit, and proper dosing verification. Start renewal preparation 3

If Kesimpta Isn't Approved by Blue Cross Blue Shield in New York: Formulary Alternatives & Exception Paths

Answer Box: Kesimpta Alternatives with BCBS New York If Blue Cross Blue Shield denies Kesimpta (ofatumumab) in New York, formulary alternatives include Ocrevus, Tysabri, Tecfidera, and interferon-based DMTs. Most BCBS NY plans require step therapy with oral or injectable DMTs before approving high-cost biologics. Your fastest path: request a formulary

How to Get Advate (Octocog Alfa) Covered by Blue Cross Blue Shield in Florida: Coding, Appeals, and Success Strategies

Answer Box: Getting Advate Covered in Florida Advate (octocog alfa) requires prior authorization from Blue Cross Blue Shield Florida, with strict documentation requirements for hemophilia A patients. Success depends on proper coding (ICD-10 D66), specialist prescribing, and comprehensive clinical documentation. Three-step fast track: 1) Gather factor VIII levels, bleed history,

How to Get Oxlumo (Lumasiran) Covered by Blue Cross Blue Shield in Ohio: Complete Appeals Guide

Answer Box: Getting Oxlumo Covered by BCBS Ohio Blue Cross Blue Shield Ohio requires prior authorization for Oxlumo (lumasiran) with strict criteria: genetic confirmation of primary hyperoxaluria type 1 (PH1), specialist prescribing, and documented urinary oxalate levels. If denied, you have 180 days for internal appeals, then external review through

Get Nucala (Mepolizumab) Covered by Blue Cross Blue Shield North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Quick Path to Nucala Coverage To get Nucala covered by Blue Cross Blue Shield North Carolina: You need prior authorization with blood eosinophils ≥150 cells/μL, documented severe asthma with ≥2 exacerbations despite high-dose inhaled therapy, and specialist involvement. Submit through the Blue e portal with complete clinical

How to Get Tegsedi (Inotersen) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Tegsedi Covered by BCBS in Pennsylvania Blue Cross Blue Shield prior authorization for Tegsedi (inotersen) requires: genetic confirmation of hATTR polyneuropathy, documented step therapy failures, REMS enrollment, and a comprehensive lab monitoring plan. If denied, you have 180 days for internal appeals, then 4 months for Pennsylvania&

How to Get Ferriprox (deferiprone) Covered by Blue Cross Blue Shield of Michigan: Complete Decision Tree & Appeal Guide

Answer Box: Getting Ferriprox Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Ferriprox (deferiprone) with specific eligibility criteria. To qualify: you must be at least 8 years old, have documented transfusional iron overload (ferritin >1000 µg/L or LIC >7 mg/g), and

How to Get HyperHEP Covered by Blue Cross Blue Shield of Texas: Forms, Appeals & Contact Guide 2025

Answer Box: Getting HyperHEP Covered by BCBS Texas Quick Path to Coverage: Most Blue Cross Blue Shield of Texas (BCBSTX) plans cover HyperHEP (hepatitis B immune globulin) for post-exposure prophylaxis when administered within 24 hours of exposure. HealthSelect members need no prior authorization as of September 2024, but require a