CommercialPrior AuthHigh impact
AB2026-04-004 Medical policies
Capital Blue Cross·Oncology, Hematology, Nephrology +2 more·Medical Policy
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross is implementing new prior authorization requirements for three new specialty injectable drugs (Yartemlea, Lunsumio Velo, Rybrevant Faspro) effective May 1, 2026, and revising prior authorization requirements for dozens of existing specialty injectables effective June 1, 2026. The C9399 temporary code will now require prior authorization for many drugs previously covered without authorization.
Action Required
By May 1, 2026: Update billing system to require prior authorization for new drugs using codes J3590, J9350, J9999, and C9399. By June 1, 2026: Implement prior authorization requirements for revised specialty injectable policies including C9399 code for multiple existing drugs. Staff must submit prior auth requests through Prime MPS GatewayPA Portal at GatewayPA.com or call 800.424.1710 for urgent requests. Failure to obtain prior authorization will result in claim denials.