Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 112 issues

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.

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in New Jersey: Prior Authorization Guide & Appeals Process

Answer Box: Getting Epidiolex Covered by Blue Cross Blue Shield in New Jersey Epidiolex requires prior authorization under Horizon Blue Cross Blue Shield of New Jersey and must be dispensed through a specialty pharmacy. Your fastest path to approval: 1. Confirm diagnosis: Ensure you have a documented diagnosis of Lennox-Gastaut

How to Get Crysvita (burosumab) Covered by Blue Cross Blue Shield in Ohio: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Crysvita Covered in Ohio Blue Cross Blue Shield Ohio requires prior authorization for Crysvita (burosumab), with step therapy requiring failure of oral phosphate and vitamin D first. Coverage is restricted to FDA-approved uses (X-linked hypophosphatemia and tumor-induced osteomalacia) with specialist prescription. If denied, you have 180 days

How to Get Rinvoq (upadacitinib) Covered by Blue Cross Blue Shield in New York: Complete Guide to Forms, Appeals & Approval

Answer Box: Getting Rinvoq Covered by BCBS New York Blue Cross Blue Shield New York requires prior authorization for Rinvoq (upadacitinib), typically with step therapy requirements. Your fastest path to approval: (1) Have your doctor complete the BCBS PA form with detailed medical necessity documentation, (2) Submit through the Availity

How to Get Orfadin (nitisinone) Covered by Blue Cross Blue Shield in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Orfadin Covered by Blue Cross Blue Shield in New Jersey Orfadin (nitisinone) requires prior authorization from Blue Cross Blue Shield in New Jersey. To get approved: (1) Confirm your HT-1 diagnosis with elevated succinylacetone levels and genetic testing, (2) Have your specialist submit a prior authorization request

Complete Guide: Getting Uplizna (Inebilizumab) Covered by Blue Cross Blue Shield in Washington State

Answer Box: Fastest Path to Uplizna Coverage in Washington Who qualifies: Adults with AQP4-positive NMOSD or IgG4-related disease. Step 1: Confirm your Blue Cross Blue Shield plan requires prior authorization (most do). Step 2: Your neurologist submits a PA request with AQP4-IgG test results, diagnosis documentation, and failed therapy history.

How to Get Firazyr (Icatibant) Covered by Blue Cross Blue Shield in Ohio: Complete Guide with Forms and Appeals Process

Quick Answer: Getting Firazyr Covered by BCBS Ohio Blue Cross Blue Shield Ohio requires prior authorization for Firazyr (icatibant) for hereditary angioedema (HAE) treatment. Start today by: 1) Confirming your HAE diagnosis documentation with an immunologist/allergist, 2) Having your doctor submit the PA request through Anthem's provider

Blue Cross Blue Shield North Carolina Coverage Criteria for Jakafi (Ruxolitinib): Complete Prior Authorization Guide

Answer Box: Getting Jakafi Covered by Blue Cross Blue Shield NC Jakafi (ruxolitinib) requires prior authorization from Blue Cross Blue Shield of North Carolina and must be filled at an in-network specialty pharmacy. To get approved: 1. Submit comprehensive PA request with diagnosis documentation (myelofibrosis, polycythemia vera, or GVHD), prior