CommercialCoverageMedium impact
Radiopharmaceuticals for the Treatment of Cancer 6.01.44
Excellus BlueCross BlueShield·Oncology, Nuclear Medicine, Urology·Cancer Treatment (Oncology)
Effective date
Oct 15, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their radiopharmaceuticals policy for cancer treatment, establishing specific coverage criteria for advanced treatments like Xofigo, Pluvicto, Lutathera, Strontium-89, and HICON. The policy defines detailed medical necessity requirements including specific diagnostic criteria, prior treatments, and clinical parameters that must be met for coverage approval.
Action Required
Before October 15, 2025: Clinical staff must review and implement new prior authorization criteria for radiopharmaceutical cancer treatments. Update EMR templates to include required documentation elements such as PSMA-positive status for Pluvicto, bone metastases confirmation for Xofigo, and SSTR-positive status for Lutathera. Billing team should coordinate with oncology providers to ensure all clinical requirements are documented before submitting claims to avoid denials.