High impact
AB2026-09-005 Medical policies
Capital Blue Cross·Effective Oct 1, 2026
Capital Blue Cross has updated 50+ medical specialty injectable policies and several general medical policies effective October 1 and November 1, 2026. New prior authorization requirements apply to Decnupaz (J9999, C9399) and new biosimilars Filkri and Immgolis Intri. Medical specialty injectable policies have been delegated to Prime Therapeutics (MPS) with updated clinical criteria and a new online submission portal (GatewayPA). Billing teams must identify affected injectable medications in their patient population and implement new prior authorization workflows.