All Insurance Policy Changes (Page 1165)

Continuing from page 1164. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
08.00.62r, Abatacept (Orencia®) for Injection for Intravenous Use
Independence Blue Cross·Effective Oct 1, 2025
This is an update to the policy for Abatacept (Orencia®) injection for intravenous use under the pharmacy category. The policy has been updated for commercial plans with an effective date of October 1, 2025.
Medium impact
00.06.02aw, Preventive Care Services
Independence Blue Cross·Effective Oct 1, 2025
This is a commercial policy update for preventive care services that became effective October 1, 2025. The policy content summary indicates changes to preventive care coverage or billing requirements for commercial insurance plans.
Medium impact
00.01.25bt, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Independence Blue Cross·Effective Oct 1, 2025
Updated PPO network rules for specialty services including durable medical equipment, laboratory, radiology, and physical medicine/rehabilitation services. This is a commercial policy update that will take effect on October 1, 2025, affecting how these specialty services are provided within the network.
Medium impact
05.00.35g, Foot Orthotics and Other Podiatric Appliances
Independence Blue Cross·Effective Oct 1, 2025
IBX Commercial updated their policy 05.00.35g for Foot Orthotics and Other Podiatric Appliances, effective October 1, 2025. This is a fresh policy update that may impact coverage, billing requirements, or prior authorization for podiatric appliances and foot orthotic devices.
Medium impact
00.03.07aq, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Independence Blue Cross·Effective Oct 1, 2025
Independence Blue Cross updated their laboratory services policy for HMO and HMO-POS products. This is a commercial policy update that will be effective October 1, 2025, but specific details of the changes are not provided in the summary-only content.
High impact
00.03.06g, Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Serv
Independence Blue Cross·Effective Oct 1, 2025
This policy (effective 10/01/2025) establishes reimbursement eligibility for Physical Medicine and Rehabilitation (PM&R) services provided by PT/OT providers to HMO and HMO-POS members above capitation rates. This change allows PT/OT providers to receive additional reimbursement beyond their capitated arrangements for covered rehabilitation services, potentially increasing revenue opportunities for these providers.
Medium impact
11.03.15m, Gastric Electrical Stimulation (Enterra™), Gastric Pacing
Independence Blue Cross·Effective Oct 1, 2025
The IBX Commercial policy for Gastric Electrical Stimulation (Enterra™) and Gastric Pacing has been updated with new coverage criteria or billing requirements effective October 1, 2025. This affects billing for gastric stimulator devices and related procedures.
Medium impact
01.00.12d, Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
Independence Blue Cross·Effective Oct 1, 2025
Policy 01.00.12d regarding anesthesia services for epidural, paravertebral facet and sacroiliac joint injections for spinal joint management has been updated for commercial plans. This policy affects billing for anesthesia services related to spinal pain management procedures.
Medium impact
07.03.09x, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross·Effective Oct 1, 2025
Independence Blue Cross has updated their medical policy for electromyography (EMG) studies, nerve conduction studies (NCS), and related electrodiagnostic procedures, effective October 1, 2025. This commercial policy update may affect coverage criteria, billing requirements, or documentation standards for these neurological diagnostic tests.
Medium impact
07.13.07m, Corneal Pachymetry Using Ultrasound
Independence Blue Cross·Effective Oct 1, 2025
This is a commercial policy update for corneal pachymetry using ultrasound procedures. The policy has been updated but specific changes are not detailed in the summary provided.
Low impact
08.01.88a, Allogeneic Processed Thymus Tissue-agdc (Rethymic®)
Independence Blue Cross·Effective Oct 1, 2025
A new commercial policy for Allogeneic Processed Thymus Tissue-agdc (Rethymic®) has been updated, affecting pharmacy coverage for this specialized thymus tissue product. The policy appears to establish coverage criteria or billing guidelines for this therapeutic product.
Medium impact
08.02.02b, Ublituximab-xiiy (Briumvi®) for intravenous use
Independence Blue Cross·Effective Oct 1, 2025
A new policy for Ublituximab-xiiy (Briumvi®) intravenous medication has been updated for commercial plans. This is a pharmacy policy change that affects billing and coverage for this specific medication used for multiple sclerosis treatment.
Medium impact
08.01.38e, Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™)
Independence Blue Cross·Effective Oct 1, 2025
This is a new or updated pharmacy policy for Ocrelizumab (Ocrevus) and Ocrelizumab with Hyaluronidase-ocsq (Ocrevus Zunovo), used primarily for multiple sclerosis treatment. The policy became effective October 1, 2025 and may affect coverage, prior authorization requirements, or administration billing for these specialty medications.
Medium impact
08.00.64i, Natalizumab (Tysabri®) and Related Biosimilars
Independence Blue Cross·Effective Oct 1, 2025
Independence Blue Cross updated their policy for Natalizumab (Tysabri®) and related biosimilars under their commercial plans. This pharmacy policy became effective October 1, 2025, though specific details about coverage changes, prior authorization requirements, or billing modifications are not provided in the summary.
Medium impact
08.00.74aa, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Independence Blue Cross·Effective Oct 1, 2025
This policy, effective October 1, 2025, establishes coverage and billing guidelines for intravitreal injections of VEGF antagonists, VEGF biosimilars, and combination VEGF/Ang-2 inhibitors used to treat retinal conditions. The billing team must review the full policy text to identify specific prior authorization requirements, covered medications, dosing limits, and any billing code updates that may affect claim processing for these ophthalmic pharmacy procedures.
Medium impact
08.01.22e, Alemtuzumab (Lemtrada®)
Independence Blue Cross·Effective Oct 1, 2025
IBX Commercial has updated their policy 08.01.22e for Alemtuzumab (Lemtrada®), a specialty pharmacy medication. This is a fresh policy update that took effect October 1, 2025, but specific details about coverage, prior authorization, or billing changes are not provided in the summary.
Medium impact
05.00.21ah, Durable Medical Equipment (DME) and Consumable Medical Supplies
Independence Blue Cross·Effective Oct 1, 2025
This is a commercial insurance policy update for Durable Medical Equipment (DME) and Consumable Medical Supplies that became effective October 1, 2025. The policy change affects how commercial plans handle coverage and billing for medical equipment and supplies, though specific details require accessing the full policy document.
Medium impact
08.01.08u, Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents
Independence Blue Cross·Effective Oct 1, 2025
This is a commercial insurance policy update regarding coverage of anticancer prescription oral and injectable drugs, biologics, and supportive agents. The policy appears to be a routine update to existing coverage guidelines for cancer treatments under commercial plans.
Medium impact
08.00.78av, Self-Administered Drugs and Biologics
Independence Blue Cross·Effective Oct 1, 2025
Policy 08.00.78av regarding Self-Administered Drugs and Biologics has been updated for commercial plans, effective October 1, 2025. This is a very recent pharmacy-related policy change that may affect billing and coverage for self-administered medications and biologic treatments.
Medium impact
08.00.55m, Omalizumab (Xolair®)
Independence Blue Cross·Effective Oct 1, 2025
Policy 08.00.55m for Omalizumab (Xolair®) has been updated under commercial plans effective October 1, 2025. This pharmacy policy change may affect coverage criteria, prior authorization requirements, or billing procedures for this specialty medication used primarily for asthma and chronic urticaria treatment.
Medium impact
08.01.91a, Inclisiran (Leqvio®)
Independence Blue Cross·Effective Oct 1, 2025
Insurance policy for Inclisiran (Leqvio®) pharmacy coverage has been updated with new commercial plan requirements. This affects billing and coverage for this cholesterol-lowering medication that requires specialized handling.
Medium impact
08.01.76d, Evinacumab-dgnb (Evkeeza®)
Independence Blue Cross·Effective Oct 1, 2025
Independence Blue Cross has updated their pharmacy policy for Evinacumab-dgnb (Evkeeza®), a specialty medication used to treat homozygous familial hypercholesterolemia. This is a fresh commercial policy update that may affect coverage criteria, prior authorization requirements, or billing procedures for this high-cost specialty drug.
Medium impact
08.00.57t, Treatments for Complex Regional Pain Syndrome (CRPS)
Independence Blue Cross·Effective Oct 1, 2025
Independence Blue Cross updated their medical policy 08.00.57t for Complex Regional Pain Syndrome (CRPS) treatments effective October 1, 2025. This is a commercial plan policy update that may affect coverage criteria, prior authorization requirements, or billing procedures for CRPS-related treatments and procedures.
Medium impact
08.00.41c, Teprotumumab-trbw (Tepezza®)
Independence Blue Cross·Effective Oct 1, 2025
Independence Blue Cross has updated their pharmacy policy for Teprotumumab-trbw (Tepezza®), effective October 1, 2025. This is a fresh policy update that may affect coverage criteria, prior authorization requirements, or billing procedures for this thyroid eye disease medication.
Medium impact
11.08.20aq, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Independence Blue Cross·Effective Oct 1, 2025
A wound care policy for skin substitutes used in treating burns and chronic, non-healing wounds has been updated for commercial insurance plans. This is a very recent policy change that may affect billing procedures and coverage criteria for wound care treatments.

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Archive by year

2023 2024 2025 2026

08.00.62r, Abatacept (Orencia®) for Injection for Intravenous Use

00.06.02aw, Preventive Care Services

00.01.25bt, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services

05.00.35g, Foot Orthotics and Other Podiatric Appliances

00.03.07aq, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

00.03.06g, Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Serv

11.03.15m, Gastric Electrical Stimulation (Enterra™), Gastric Pacing

01.00.12d, Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management

07.03.09x, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies

07.13.07m, Corneal Pachymetry Using Ultrasound

08.01.88a, Allogeneic Processed Thymus Tissue-agdc (Rethymic®)

08.02.02b, Ublituximab-xiiy (Briumvi®) for intravenous use

08.01.38e, Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™)

08.00.64i, Natalizumab (Tysabri®) and Related Biosimilars

08.00.74aa, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors

08.01.22e, Alemtuzumab (Lemtrada®)

05.00.21ah, Durable Medical Equipment (DME) and Consumable Medical Supplies

08.01.08u, Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents

08.00.78av, Self-Administered Drugs and Biologics

08.00.55m, Omalizumab (Xolair®)

08.01.91a, Inclisiran (Leqvio®)

08.01.76d, Evinacumab-dgnb (Evkeeza®)

08.00.57t, Treatments for Complex Regional Pain Syndrome (CRPS)

08.00.41c, Teprotumumab-trbw (Tepezza®)

11.08.20aq, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds