High impact
AB2026-08-005 Medical policies
Capital Blue Cross·Effective Sep 1, 2026
Capital Blue Cross has updated medical policies effective September 1 and October 1, 2026, affecting injectable specialty drugs, medical devices, and surgical procedures. Key changes include new prior authorization requirements for four specialty injectable drugs (Otarmeni, Wainua, Nufymco, and Evdi), revised step therapy requirements for multiple oncology and hematology medications, updated coverage criteria for cochlear implants (age lowered to 7 months), and reorganization of prostate cancer treatment policies. Multiple surgical and diagnostic procedure codes have been added, removed, or reclassified.