AB2026-10-005 Medical policies
Capital Blue Cross updated its medical policies with an effective date of November 1, 2026 unless otherwise indicated, and many revisions take effect December 1, 2026. Changes include new prior authorization for J9999 and C9399 (Sarclisa Escena) effective November 1, 2026, and for J9041, J9046, J9048, J9049, J9054 and J9999 (bortezomib) and J9292 (Axtle) effective December 1, 2026, along with new step therapy requirements for several drugs. Other revisions remove prior authorization for procedure codes 34701, 34703, 34705, 34707, 96920, 96921, 96922 and 64566, add prior authorization for 17106, 17107 and 17108, and list L2006 as non-covered once it is removed from prior authorization.