CommercialCoverageMedium impact
Multibiomarker Disease Activity Blood Test for Rheumatoid Arthritis (2.04.119)
Blue Shield of California·CA · Rheumatology·Medical Policy
Effective date
Nov 1, 2025
We identified it
Nov 1, 2025
Summary
Blue Shield of California has updated their policy effective November 1, 2025, declaring that multibiomarker disease activity blood tests for rheumatoid arthritis (such as the Vectra score) are considered investigational in all situations. This means these tests will not be covered as the evidence is insufficient to demonstrate they improve patient outcomes compared to existing disease activity measures.
Action Required
Before November 1, 2025: Billing team must update systems to flag that Blue Shield of California will not cover multibiomarker disease activity tests (Vectra score) for rheumatoid arthritis as they are considered investigational. Providers should be notified to use alternative validated disease activity measures like DAS28. Claims for these tests will likely be denied.