AB2026-02-003 Medical policies
Capital Blue Cross updated its medical policies with an effective date of March 1, 2026 unless otherwise indicated, and it delegated the medical specialty injectable policies to Prime Medical Pharmacy Solutions, which is making them more medication-specific for Commercial members with changed prior authorization periods for some drugs. Blenrep is a new policy, HCPCS code J9999 now requires prior authorization for it, and numerous injectables, including Botox, Opdivo SQ, Trastuzumab IV and Ocrevus IV, have revised policies effective 4/1/2026. Commercial knee brace codes L1834, L1840 and L1846 no longer require prior authorization because they are investigational, code 0707T now requires prior authorization under the Experimental and Investigational Procedures policy, and several Medicare Advantage medical policies were retired effective March 1, 2026.