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Medical Policy and Coding Updates - May 2026
Premera Blue Cross·WA · Oncology, Rheumatology, Cardiology +7 more·Medical Policy
Effective date
May 1, 2026
We identified it
Jun 16, 2026
Summary
Premera Blue Cross updated multiple medical and pharmacy policies effective between May 1, 2026 and August 7, 2026, including new site of service reviews for various infusion drugs, updated medical necessity criteria for immune globulin therapy and denosumab products, and new policies for prostate artery embolization and hematopoietic cell transplantation.
Action Required
By May 1, 2026: Billing teams must update prior authorization requirements for multiple drugs now subject to site of service review including Amvuttra, Onpattro, Yimmugo, Givlaari, Keytruda Qlex, Leqvio, and Rystiggo. Update system to flag prostate artery embolization as investigational. By June 5, 2026: Add site of service review requirements for carpal tunnel release and upper GI endoscopy procedures. By July 1, 2026: Update UGI endoscopy procedures for site of service review. By August 7, 2026: Update denosumab product preferences requiring step therapy through preferred products before non-preferred options.