Blue Cross Blue Shield of Massachusetts · Prior auth
Blue Cross Blue Shield of Massachusetts prior authorization criteria
Submission criteria, documentation packets, and P2P prep by drug — for prescribers and PA staff. 30-day standard PA decision.
Standard PA decision
30 days
Appeal window if denied
180 days
Drugs covered
62
Blue Cross Blue Shield of Massachusetts reviews prior-authorization requests against its published medical policies — diagnosis with ICD-10 code, documented step-therapy history, and prescriber attestation of medical necessity. Standard PA decisions return in 30 days; if denied, prescribers and members have 180 days to appeal. Criteria by drug below.
Prior authorization criteria by drug
Each page covers Blue Cross Blue Shield of Massachusetts's submission criteria, the documentation packet, and peer-to-peer prep for that drug.
- Adalimumab at Blue Cross Blue Shield of Massachusetts →
- Aflibercept at Blue Cross Blue Shield of Massachusetts →
- Apixaban at Blue Cross Blue Shield of Massachusetts →
- Atezolizumab at Blue Cross Blue Shield of Massachusetts →
- Atogepant at Blue Cross Blue Shield of Massachusetts →
- Benralizumab at Blue Cross Blue Shield of Massachusetts →
- Bevacizumab at Blue Cross Blue Shield of Massachusetts →
- Bictegravir at Blue Cross Blue Shield of Massachusetts →
- Buprenorphine at Blue Cross Blue Shield of Massachusetts →
- Dapagliflozin at Blue Cross Blue Shield of Massachusetts →
- Dulaglutide at Blue Cross Blue Shield of Massachusetts →
- Dupilumab at Blue Cross Blue Shield of Massachusetts →
- Eculizumab at Blue Cross Blue Shield of Massachusetts →
- Elexacaftor Tezacaftor Ivacaftor at Blue Cross Blue Shield of Massachusetts →
- Empagliflozin at Blue Cross Blue Shield of Massachusetts →
- Erenumab at Blue Cross Blue Shield of Massachusetts →
- Evolocumab at Blue Cross Blue Shield of Massachusetts →
- Faricimab at Blue Cross Blue Shield of Massachusetts →
- Fingolimod at Blue Cross Blue Shield of Massachusetts →
- Fremanezumab at Blue Cross Blue Shield of Massachusetts →
- Galcanezumab at Blue Cross Blue Shield of Massachusetts →
- Glecaprevir Pibrentasvir at Blue Cross Blue Shield of Massachusetts →
- Guselkumab at Blue Cross Blue Shield of Massachusetts →
- Ibrutinib at Blue Cross Blue Shield of Massachusetts →
- Imatinib at Blue Cross Blue Shield of Massachusetts →
- Inclisiran at Blue Cross Blue Shield of Massachusetts →
- Infliximab at Blue Cross Blue Shield of Massachusetts →
- Ixekizumab at Blue Cross Blue Shield of Massachusetts →
- Lenalidomide at Blue Cross Blue Shield of Massachusetts →
- Liraglutide at Blue Cross Blue Shield of Massachusetts →
- Lisdexamfetamine at Blue Cross Blue Shield of Massachusetts →
- Mepolizumab at Blue Cross Blue Shield of Massachusetts →
- Methylphenidate at Blue Cross Blue Shield of Massachusetts →
- Naltrexone at Blue Cross Blue Shield of Massachusetts →
- Natalizumab at Blue Cross Blue Shield of Massachusetts →
- Nintedanib at Blue Cross Blue Shield of Massachusetts →
- Nivolumab at Blue Cross Blue Shield of Massachusetts →
- Nusinersen at Blue Cross Blue Shield of Massachusetts →
- Ocrelizumab at Blue Cross Blue Shield of Massachusetts →
- Ofatumumab at Blue Cross Blue Shield of Massachusetts →
- Omalizumab at Blue Cross Blue Shield of Massachusetts →
- Ozanimod at Blue Cross Blue Shield of Massachusetts →
- Palbociclib at Blue Cross Blue Shield of Massachusetts →
- Pembrolizumab at Blue Cross Blue Shield of Massachusetts →
- Pirfenidone at Blue Cross Blue Shield of Massachusetts →
- Ribociclib at Blue Cross Blue Shield of Massachusetts →
- Rimegepant at Blue Cross Blue Shield of Massachusetts →
- Risankizumab at Blue Cross Blue Shield of Massachusetts →
- Rituximab at Blue Cross Blue Shield of Massachusetts →
- Rivaroxaban at Blue Cross Blue Shield of Massachusetts →
- Sacubitril Valsartan at Blue Cross Blue Shield of Massachusetts →
- Secukinumab at Blue Cross Blue Shield of Massachusetts →
- Semaglutide at Blue Cross Blue Shield of Massachusetts →
- Sofosbuvir at Blue Cross Blue Shield of Massachusetts →
- Tafamidis at Blue Cross Blue Shield of Massachusetts →
- Tenofovir Alafenamide at Blue Cross Blue Shield of Massachusetts →
- Tezepelumab at Blue Cross Blue Shield of Massachusetts →
- Tirzepatide at Blue Cross Blue Shield of Massachusetts →
- Tofacitinib at Blue Cross Blue Shield of Massachusetts →
- Trastuzumab at Blue Cross Blue Shield of Massachusetts →
- Upadacitinib at Blue Cross Blue Shield of Massachusetts →
- Ustekinumab at Blue Cross Blue Shield of Massachusetts →
Generate a Blue Cross Blue Shield of Massachusetts PA packet
Open ApprovalHelp — generate a prior-auth packet tailored to Blue Cross Blue Shield of Massachusetts's criteria, with prescriber attestation and step-therapy documentation pre-filled.
Get started →Contact: hello@approvalhelp.com