CommercialCoverageHigh impact
Testing for the Use of Biologic Therapeutics for the Treatment of Inflammatory Disorders 2.02.47
Excellus BlueCross BlueShield·Gastroenterology, Rheumatology, Dermatology·Lab Tests (pathology)
Effective date
Nov 20, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has declared all testing for biologic drug levels and antibodies (like Infliximab, Adalimumab, Vedolizumab, Ustekinumab) as investigational and non-covered, including specific tests like Anser IFX, Anser ADA, and PrismRA. This policy also covers predictive testing for biologic therapy response.
Action Required
By November 20, 2025: Billing team must update systems to flag all therapeutic drug monitoring tests for biologic therapies as non-covered/investigational for Excellus BCBS members. Stop billing for Anser tests, Procise tests, PredictrPK IFX, ADALX, and PrismRA without patient financial responsibility discussions. Notify providers that these tests will not be reimbursed and require patient consent for out-of-pocket payment.