High impact
AB2026-08-002 Medicare only
Capital Blue Cross·Effective Sep 1, 2026
Capital Blue Cross has updated step therapy requirements for Medicare Advantage Part B medications effective September 1 and October 1, 2026. Four drugs have revised non-preferred product lists (Armlupeg, Exdensur, Nufymco, Eydenzelt), three new drugs require trial/failure of specific alternatives (Kyxata, Avgemsi, Inlexzo), and Fulphila moved to preferred status while Neulasta moved to non-preferred status. Billing teams must implement these step therapy changes to avoid claim denials for Medicare Advantage members.