CommercialCoverageMedium impact
Medical Policy and Coding Updates - May 2025
Premera Blue Cross·WA, AK · Oncology, Hematology, Rheumatology +7 more·Medical Policy
Effective date
May 1, 2025
We identified it
Jun 16, 2026
Summary
Premera Blue Cross has released comprehensive medical and pharmacy policy updates for May 2025, including new genetic testing guidelines, updated drug coverage criteria, and new investigational determinations. Key changes include updated criteria for various specialty medications, new policies for genetic testing procedures, and coverage updates for biologic therapies across multiple therapeutic areas.
Action Required
By August 1, 2025: Billing team must update genetic testing claims to use sample collection date as the date of service instead of processing date. By July 26, 2025: Update prior authorization requirements for genetic testing including chromosomal microarray analysis, whole exome sequencing, and pharmacogenomic testing per new Carelon guidelines. Immediately: Review and update formulary preferences for adalimumab products (Humira now non-preferred), update G-CSF product tier preferences (Udenyca moved to first-line for pediatric patients), and verify coverage criteria for newly added bispecific antibodies and rare disease medications.