High impact
AB2026-07-005 Medical policies
Capital Blue Cross·Effective Aug 1, 2026
Capital Blue Cross has implemented major updates to medical specialty injectable policies (delegated to Prime MPS for Commercial plans) and revised multiple non-injectable medical policies effective August 1-September 1, 2026. Two new drugs (Kresladi and Avlayah) now require prior authorization, multiple biosimilars require new prior auth (Denosumab, Neulasta), and over 40 existing injectable drugs have revised policies. Additionally, several procedural policies have been restructured with new codes and changed medical necessity determinations.