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BlueSpeak June 2026: Pharmacy Policy Updates

Blue Cross and Blue Shield of Kansas City·MO · Pharmacy, Cardiology, Dermatology +6 more·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jun 1, 2026
Days to comply
5 days

Summary

Blue KC is implementing comprehensive pharmacy formulary updates across three commercial plan tiers (Premium, Select, and Essential Health Benefits) effective July 1, 2026. Changes include new prior authorization requirements for specific drugs, exclusions of certain medications with covered alternatives, exclusion of branded drugs with generic equivalents, and mandatory specialty pharmacy transition for three medications (Temozolomide, Fingolimod, Everolimus) through Lumicera Specialty Pharmacy.

Action Required

Before Jul 1, 2026
By June 15, 2026: Billing and clinical teams must coordinate to implement the following changes: (1) Update billing system to require prior authorization for Arbli suspension 10 mg/mL and Depen tablet 250 mg across all affected commercial plans. (2) Configure system to automatically flag the following medications as excluded with covered alternatives: sertraline capsule (150-200 mg), ondansetron tab 16mg ODT, valsartan solution, Vyalev injection, abiraterone tab 500 mg, Twyneo cream, triamterene cap, glycerol phe liq, Zegalogue injection, Premarin tablet, baclofen sol, and ciprofloxacin-hydrocortisone suspension—with system prompts to suggest documented alternatives. (3) Configure system to deny coverage and direct to generic equivalents for: Complera, Dificid, Dyrenium, Iressa, Korlym, Lovenox, Motegrity, Nexavar, NuvaRing, Pradaxa, Promacta, Purixan, Rytary, Tasigna, and Thalitone (for Premium plan). (4) Add step therapy requirement in billing system for NuvaRing on Select formulary requiring generic equivalent trial first. (5) Notify all prescribers that effective July 1, 2026, Temozolomide (5mg, 20mg, 100mg, 140mg, 180mg, 250mg), Fingolimod (0.5mg), and Everolimus (0.5mg, 5mg, 7.5mg, 10mg) MUST be dispensed through Lumicera Specialty Pharmacy exclusively; claims submitted to other pharmacies will be denied. (6) Update prior authorization templates to reference Lumicera for these three medications. (7) Front desk and patient communication staff must be prepared to direct members to Lumicera information provided in member letters. Failure to implement these changes will result in claim denials, member access disruptions, and prescription rejections. Billing team must test all system changes in sandbox environment by June 20, 2026.
BlueSpeak June 2026: Pharmacy Policy Updates | Blue Cross and Blue Shield of Kansas City | PolicyChanges.app