Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1266 issues

Blue Cross Blue Shield New York Coverage Criteria for Rezlidhia (Olutasidenib): Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rezlidhia Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield of New York requires prior authorization for Rezlidhia (olutasidenib) in adults with relapsed/refractory AML and susceptible IDH1 mutation. Your fastest path to approval: 1) Confirm IDH1 mutation via FDA-approved test, 2) Submit

Get Alprolix Coverage by Florida Blue Cross Blue Shield: Complete Guide to Prior Authorization, Appeals & Approvals

Answer Box: Fastest Path to Alprolix Coverage To get Alprolix covered by Florida Blue Cross Blue Shield, you'll need prior authorization through a hematologist or hemophilia specialist. Submit documentation proving moderate-to-severe hemophilia B (Factor IX ≤2%), prior treatment failures, and medical necessity. Use CVS Caremark Specialty Pharmacy or

How to Get Ibrance (palbociclib) Covered by Blue Cross Blue Shield of Texas: Complete PA Guide with Forms and Appeals

Quick Answer: Getting Ibrance Covered by BCBS Texas Ibrance (palbociclib) requires prior authorization from Blue Cross Blue Shield of Texas for all doses. Your fastest path to approval: 1) Verify your HR+/HER2- breast cancer diagnosis with pathology reports, 2) Have your oncologist submit PA through CoverMyMeds or BCBS Texas

How to Get Ocrevus (Ocrelizumab) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Timeline and Appeals Guide

Answer Box: Getting Ocrevus Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield Pennsylvania requires prior authorization for Ocrevus (ocrelizumab) with specific clinical criteria: confirmed MS diagnosis, age 18+, negative hepatitis B screening, and documentation of prior DMT trials or contraindications. Submit PA requests through your plan&

How to Get Carbaglu (Carglumic Acid) Covered by Blue Cross Blue Shield in Ohio: Forms, Appeals, and Specialty Pharmacy Guide

Answer Box: Getting Carbaglu Covered by Blue Cross Blue Shield in Ohio Carbaglu (carglumic acid) requires prior authorization from Blue Cross Blue Shield plans in Ohio for coverage of NAGS deficiency and certain organic acidemias. The fastest path to approval: (1) Submit the Anthem prior authorization form with complete diagnosis

How to Get Orladeyo (Berotralstat) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Orladeyo Covered by Blue Cross Blue Shield in New Jersey Horizon Blue Cross Blue Shield of New Jersey requires prior authorization for Orladeyo (berotralstat), a specialty-tier drug for HAE prophylaxis in patients ≥12 years old. The fastest path to approval: (1) Have your allergist/immunologist submit prior

How to Get Fintepla (fenfluramine) Covered by Blue Cross Blue Shield in Washington: Appeals Process, REMS Requirements, and State Protections

Answer Box: Getting Fintepla Covered by Blue Cross Blue Shield in Washington Fintepla (fenfluramine) requires prior authorization from Blue Cross Blue Shield with mandatory REMS enrollment and baseline echocardiography. To get approval: (1) Complete REMS enrollment at FinteplaREMS.com with baseline ECHO, (2) Submit PA with diagnosis confirmation (Dravet G40.

How to Get Cosentyx (secukinumab) Covered by Blue Cross Blue Shield of Illinois: Complete Coding, PA, and Appeals Guide

Answer Box: Getting Cosentyx Approved in Illinois Cosentyx (secukinumab) requires prior authorization through Blue Cross Blue Shield of Illinois for 2024-2025, using HCPCS code J3247 for IV formulation or J3590 for subcutaneous. Submit PA requests with proper ICD-10 codes (L40.0 for plaque psoriasis, L40.50-59 for psoriatic arthritis), tuberculosis

How to Get Gamifant (Emapalumab-lzsg) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Timeline and Appeal Guide

Answer Box: Getting Gamifant Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield requires prior authorization for Gamifant (emapalumab-lzsg) with documented HLH diagnosis using 5 of 8 HLH-2004 criteria OR genetic confirmation, plus failure/intolerance to conventional therapy (etoposide, dexamethasone, cyclosporine). Standard PA decisions take 14-30 days;

How to Get Brineura (Cerliponase Alfa) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Brineura Covered by Blue Cross Blue Shield in Pennsylvania Brineura (cerliponase alfa) requires prior authorization from Blue Cross Blue Shield plans in Pennsylvania, including Highmark and Independence Blue Cross. Coverage is approved for pediatric patients with confirmed CLN2 disease (TPP1 deficiency) when administered at specialized centers by