Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1064 issues

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

Answer Box: Getting Venclexta Covered in New Jersey Horizon Blue Cross Blue Shield of New Jersey requires prior authorization (PA) for Venclexta (venetoclax), covering it as a Tier 5 specialty drug for FDA-approved CLL/SLL and AML indications. To get approved: 1. Verify coverage via Horizon's formulary and

The Complete Checklist to Get Cystadane (betaine anhydrous) Covered by Blue Cross Blue Shield in Illinois: Forms, Appeals, and Approval Strategies

Quick Answer: Getting Cystadane Covered by BCBS Illinois Cystadane (betaine anhydrous) requires prior authorization from Blue Cross Blue Shield of Illinois for all plans. The fastest path to approval: (1) Submit PA through the Carelon Provider Portal with genetic testing confirming homocystinuria (ICD-10 E72.11 or E72.12), elevated homocysteine

Getting Tagrisso (Osimertinib) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tagrisso Covered by BCBS North Carolina Fastest Path: Tagrisso (osimertinib) requires prior authorization from Blue Cross Blue Shield of North Carolina for EGFR-mutant NSCLC. Your oncologist must document EGFR mutation testing (exon 19 deletion or L858R), disease staging, and any prior TKI failures. Submit PA via CoverMyMeds

How to Get Therakos CELLEX Photopheresis Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Therakos CELLEX Covered in North Carolina Blue Cross Blue Shield of North Carolina covers Therakos CELLEX photopheresis for FDA-approved uses like cutaneous T-cell lymphoma (CTCL) and steroid-refractory graft-versus-host disease (GVHD), but requires prior authorization. Your doctor submits a PA request through the BCBS NC provider portal with

How to Get Kesimpta (Ofatumumab) Covered by Blue Cross Blue Shield in California: Prior Authorization, Appeals & Cost Savings

Answer Box: Getting Kesimpta Covered by Blue Shield of California Kesimpta (ofatumumab) requires prior authorization from Blue Shield of California for relapsing multiple sclerosis. The fastest path to approval: 1) Submit PA request with MS diagnosis (ICD-10: G35) and documentation of failed/contraindicated alternatives like Betaseron or Copaxone, 2) Obtain

How to Get Keppra (Levetiracetam) Covered by Blue Cross Blue Shield Ohio: Cost-Saving Strategies and Appeal Guide

Answer Box: Getting Keppra Covered by BCBS Ohio Levetiracetam (generic Keppra) is typically covered on Blue Cross Blue Shield Ohio formularies as a Tier 1-2 preferred generic with $0-$15 copays. Brand Keppra requires a formulary exception with medical necessity documentation. First step today: Log into your BCBS member portal

How to Get iLink® Corneal Cross-Linking Covered by Blue Cross Blue Shield in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting iLink® Covered by BCBS Texas Blue Cross Blue Shield of Texas (BCBSTX) covers iLink® corneal cross-linking for progressive keratoconus when medically necessary per their 2024 policy. Success requires: (1) documented corneal progression (≥1 diopter change over 12 months via topography), (2) prior authorization through your ophthalmologist, and

How to Get Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in Illinois: Complete Guide to International Treatment Authorization and Appeals

Answer Box: Getting Strimvelis Covered in Illinois Strimvelis gene therapy for ADA-SCID requires special authorization from Blue Cross Blue Shield of Illinois (BCBSIL) as an experimental/international treatment. Start by calling BCBSIL member services at 1-800-892-2803 to verify international coverage benefits and request experimental treatment exception forms. Submit comprehensive medical

Myths vs. Facts: Getting Uptravi (Selexipag) Covered by Blue Cross Blue Shield in New York

Answer Box: Getting Uptravi Covered by Blue Cross Blue Shield in New York Uptravi (selexipag) requires prior authorization from Blue Cross Blue Shield plans in New York for pulmonary arterial hypertension (PAH). Success depends on documenting WHO Group I PAH via right heart catheterization, failed trials of background therapies, and

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

Answer Box: Getting Joenja Approved by BCBS in New Jersey Blue Cross Blue Shield plans in New Jersey typically require prior authorization for Joenja (leniolisib) with specific APDS diagnostic criteria. The fastest path involves: (1) confirming genetic APDS diagnosis with molecular testing, (2) submitting PA through your specialist with imaging