All PlansPrior AuthMedium impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·Oncology, Pharmacy·Pharmacy
Effective date
Jul 2, 2026
We identified it
Jul 8, 2026
Summary
Effective July 2, 2026, coverage criteria for highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) will no longer apply to aprepitant 40 mg. This means the 40 mg dose of aprepitant and its brand equivalents (Cinvanti, Emend, Focinvez, Fosaprepitant, Varubi) may have different authorization or coverage requirements than previously established.
Action Required
By June 1, 2026: Billing and clinical teams must review and update prior authorization protocols for aprepitant 40 mg formulations. Specifically, remove HEC/MEC-based criteria from authorization workflows for this dose strength. Update billing system edits and prior auth templates to reflect that the 40 mg dose is no longer subject to HEC/MEC coverage criteria. Coordinate with providers to ensure they understand the new authorization pathway. Failure to update systems may result in claim denials or delayed authorizations for aprepitant 40 mg claims submitted on or after July 2, 2026.