All PlansPrior AuthMedium impact
Romosozumab-aqqg (Evenity®)
BCBS Tennessee·TN · Endocrinology, Rheumatology, Orthopedics +3 more·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
New medical policy establishes prior authorization requirements for Romosozumab-aqqg (Evenity®) for postmenopausal osteoporosis treatment. Coverage limited to 12 monthly doses with specific documentation requirements including T-scores, FRAX assessment, and previous treatment history.
Action Required
Before July 31, 2026: Billing team must implement prior authorization requirements for Evenity® (Romosozumab-aqqg). Update billing system to flag cases needing pre-auth documentation including chart notes with fragility fracture history, T-scores, FRAX probability scores, and previous osteoporosis treatment records. Train providers on 12-month treatment limitation and required clinical criteria. Claims will require prior authorization approval before submission.