All PlansPrior AuthHigh impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Oncology, Hematology, Radiation Oncology·Medical Policy
Effective date
Sep 24, 2026
We identified it
Jul 21, 2026
Summary
Arkansas Blue Cross updated authorization renewal criteria for 8 oncology and specialty pharmaceutical drugs, effective September 24, 2026. Changes simplify renewal requirements to focus on disease stability/improvement, manageable side effects, and specific treatment parameters (e.g., no therapeutic duplication for Panitumumab, 24-month treatment limit for Retifanlimab-dlwr). Additionally, the legacy Chemotherapy for Malignancy policy (2000030) will be archived on October 24, 2026, with replacement coverage under new policy 2026011.
Action Required
By September 24, 2026: Billing and prior authorization teams must update authorization renewal workflows for policies 2021035 (Sodium Iodide I-131), 2017024 (Panitumumab), 2023033 (Retifanlimab-dlwr), 2023034 (Epcoritamab-bysp), 2018014 (Lutetium Lu 177 Dotatate), 2022029 (Bortezomib), 2023035 (Sebelipase alfa), and 2024021 (Bevacizumab/Biosimilars). Update prior auth templates and decision support systems to require documentation of: (1) condition stability or improvement with specific clinical markers (disease progression, tumor size, lab values), (2) manageable or no side effects, and (3) treatment-specific limits where applicable (e.g., verify Panitumumab is not used with cetuximab, necitumumab, erlotinib, or gefitinib; confirm Retifanlimab-dlwr has not exceeded 24 months). By October 24, 2026: Migrate all chemotherapy authorization requests from policy 2000030 to new policy 2026011; update billing system routing rules and retire references to the archived policy. Providers must document clinical response metrics at renewal to support continued coverage. Failure to align renewal criteria will result in authorization denials and claim rejections.