Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 109 issues

Get Pemazyre (Pemigatinib) Covered by Anthem Blue Cross Blue Shield Virginia: Forms, Appeals & Prior Authorization Guide

Answer Box: Getting Pemazyre (Pemigatinib) Covered in Virginia Pemazyre (pemigatinib) requires prior authorization from Anthem Blue Cross Blue Shield Virginia for cholangiocarcinoma with FGFR2 fusion. The fastest path: (1) Have your oncologist submit the PA request through Availity's Interactive Care Reviewer portal with FGFR2 testing results and prior

Renewing Arcalyst (Rilonacept) Approval with Blue Cross Blue Shield in New Jersey: Complete Guide for 2025

Answer Box: Renewing Arcalyst Coverage in New Jersey Blue Cross Blue Shield renewal of Arcalyst (rilonacept) requires updated clinical documentation showing therapeutic benefit 30 days before your current authorization expires. Key requirements include evidence of symptom improvement, normalized inflammatory markers (CRP/SAA), and lipid monitoring results. Submit renewal documentation through

Get Revcovi (Elapegademase) Covered by Blue Cross Blue Shield Illinois: Complete Guide with Forms and Appeal Steps

Answer Box: Quick Path to Revcovi Coverage Revcovi (elapegademase) is covered by Blue Cross Blue Shield of Illinois but requires specialty pharmacy dispensing and likely prior authorization. To qualify: you need confirmed ADA-SCID diagnosis (enzyme activity <1% normal or genetic testing), prescription from an immunology specialist, and documentation of

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in New York: Complete Decision Tree & Appeal Guide

Answer Box: Your Path to Epidiolex Coverage Epidiolex requires prior authorization from Blue Cross Blue Shield New York plans in 2024. You'll likely qualify if you have a confirmed diagnosis of Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex, plus documented failure of standard anti-seizure medications. First step

How to Get Therakos CELLEX Photopheresis Covered by Blue Cross Blue Shield of Texas: Appeals Guide & Forms

Answer Box: Getting CELLEX Photopheresis Covered in Texas Blue Cross Blue Shield of Texas requires prior authorization for Therakos CELLEX photopheresis. You're eligible if you have CTCL (cutaneous T-cell lymphoma) or steroid-refractory GVHD (graft-versus-host disease). First step: Have your doctor submit a PA request through the BCBS Texas

How to Get Venclexta (venetoclax) Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization Guide

Answer Box: Getting Venclexta Covered by Florida Blue Venclexta (venetoclax) requires prior authorization from Florida Blue with specific ICD-10 codes, tumor lysis syndrome monitoring plans, and proper HCPCS billing. Most approvals succeed when you: (1) Submit complete prior authorization with correct diagnosis codes (C91.10 for CLL, C83.00 for

How to Get Busulfex (Busulfan Injection) Covered by Blue Cross Blue Shield of North Carolina: Forms, Appeals, and State Protections

Quick Answer: Getting Busulfex Covered in North Carolina Busulfex (busulfan injection) requires prior authorization with Blue Cross Blue Shield of North Carolina for most plans. Submit PA requests via the Blue E portal with comprehensive clinical documentation including diagnosis, prior therapies, and transplant conditioning rationale. If denied, you have 180

How to Get Keytruda (pembrolizumab) Covered by Blue Cross Blue Shield in New Jersey: Forms, Appeals, and Provider Collaboration Guide

Answer Box: Getting Keytruda Covered in New Jersey Blue Cross Blue Shield requires prior authorization for Keytruda (pembrolizumab) in New Jersey. The fastest path: Submit a complete PA request with diagnosis, PD-L1 testing results (when required), and prior treatment documentation. If denied, you have 60 days to file an external

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

Answer Box: Keppra Coverage by Blue Cross Blue Shield in North Carolina Good news: Generic levetiracetam (Keppra) is covered on Blue Cross NC's 2024 formularies without prior authorization. Brand-name Keppra requires medical necessity documentation showing generic failure or intolerance. If denied, appeal internally first, then request external review

Get Fintepla (Fenfluramine) Covered by Blue Cross Blue Shield in North Carolina: Complete Guide

Answer Box: Getting Fintepla Approved by BCBS North Carolina Fintepla (fenfluramine) is covered by Blue Cross Blue Shield North Carolina but requires prior authorization and REMS enrollment. Here's your fastest path to approval: 1. Enroll in REMS program - Both patient and prescriber must complete enrollment at FinteplarREMS.