CommercialPrior AuthHigh impact
AB2026-05-006 Medical policies
Capital Blue Cross·Oncology, Rheumatology, Dermatology +6 more·Medical Policy
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross is implementing major changes to medical specialty injectable policies and multiple medical policies. A new drug Exdensur will require prior authorization, over 30 injectable medications will have revised policies, and new prior authorization requirements are being added for bio-engineered skin substitutes and other procedures.
Action Required
By June 1, 2026: Update billing systems to require prior authorization for new drug Exdensur (codes J3590, C9399). By July 1, 2026: Review and update prior authorization workflows for 30+ revised injectable medication policies including Cimzia, Fasenra, Nucala, and others - submit requests via Prime MPS GatewayPA Portal or call 800.424.1710. Update systems to require PA for bio-engineered skin substitute codes 15271, 15273, 15275, 15277, 15011, 15013, 15015, 15017, G0681, G0683. Remove retired code J9295 (Portrazza) from billing systems.