CommercialCoverageMedium impact
08.01.71, Collagenase clostridium histolyticum (Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)
Independence Blue Cross·Pharmacy, Dermatology, Plastic Surgery·Pharmacy
Effective date
Jul 8, 2026
We identified it
Jul 9, 2026
Summary
Policy 08.01.71 covering Xiaflex® (collagenase clostridium histolyticum) and Qwo® (collagenase clostridium histolyticum-aaes) has been reissued for commercial plans effective 07/08/2026. This is a pharmacy policy update that requires immediate review to identify coverage criteria, prior authorization requirements, and any billing changes that may affect claims processing.
Action Required
By 07/08/2026: Billing team must review the full policy text at the provided URL to identify: (1) prior authorization requirements for Xiaflex® and Qwo® claims, (2) any specific HCPCS J-codes or drug codes affected, (3) coverage limitations or medical necessity criteria, and (4) documentation requirements. Update billing system rules, prior auth workflows, and provider education materials accordingly. Ensure all staff dispensing or billing for these collagenase products are aware of updated coverage terms. Contact the payer directly if specific billing codes or prior auth thresholds are unclear. Failure to comply with updated requirements may result in claim denials or payment delays.