CommercialAdministrativeMedium impact
Coverage Eligibility of Services Associated With a Clinical Trial For Non Grandfathered Plans
BCBS Arizona·AZ · Oncology·Medical Policy
Effective date
Jul 15, 2025
We identified it
Jun 16, 2026
Summary
BCBS Arizona has updated coverage policy for clinical trial services for non-grandfathered plans. The policy requires notification to BCBSAZ when members enroll in clinical trials and covers usual and customary services like lab work, radiology, physician visits, and FDA-approved medications associated with eligible clinical trials.
Action Required
By July 15, 2025: Billing team must establish process to notify BCBS Arizona when patients enroll in clinical trials. Update intake forms and EMR to flag clinical trial participants. Ensure documentation shows services are usual and customary (non-investigational). Failure to notify BCBSAZ will result in benefit administration under other plan terms and may cause claim denials.