CommercialCoverageMedium impact
Upcoming changes to the Most Cost-Effective Setting program effective July 1, 2026
AmeriHealth New Jersey·NJ · Oncology, Rheumatology, Gastroenterology +2 more·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
AmeriHealth is updating their Most Cost-Effective Setting (MCES) program which affects where certain specialty medical benefit drugs can be administered and billed. This change will impact billing locations and potentially reimbursement for specialty drug administration.
Action Required
Before July 1, 2026: Billing team must obtain updated list of specialty medical benefit drugs included in the MCES program from AmeriHealth. Review current drug administration billing practices to ensure compliance with new setting requirements. Monitor AmeriHealth communications for specific drug lists and approved administration sites.