All PlansCoverageMedium impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·Pharmacy, Oncology, Dermatology +2 more·Pharmacy
Effective date
Aug 20, 2026
We identified it
Jul 30, 2026
Summary
This pharmacy policy update, effective 08/20/2026, makes multiple drug formulary changes across 11 medications/drug classes: adds Trimbow to target drug list, restructures hydrocortisone acetate and corticosteroid criteria while removing brand references, removes discontinued products (Loprox, Mentax, Patanase, Beconase AQ, Symjepi), updates Voquezna quantity limits and approval duration, changes testosterone product coverage language from 'gender dysphoria' to 'gender-affirming care,' updates Zoryve age requirements, expands Truqap to include prostate cancer coverage, and consolidates fulvestrant product coverage. Billing and prior authorization teams must update drug formulary files and coverage criteria across all affected plan types.
Action Required
By 08/20/2026: Pharmacy and billing teams must update drug formulary databases and prior authorization systems to reflect all coverage criteria changes. Specific actions: (1) Add Trimbow to target drug list in billing software; (2) Update hydrocortisone acetate coverage criteria and remove brand Impeklo, Synalar, Tridesilon, and Verdeso references across Standard, Metallic Essential, and Complete plans; (3) Reclassify Halcinonide solution 0.1% from brand to generic in Standard plan criteria; (4) Remove Loprox brand and Mentax entirely from target drug lists (retain generic Loprox for Standard plan); (5) Remove brand Patanase and brand Beconase AQ from target drug lists (retain generic alternatives); (6) Remove Symjepi from all criteria and limit charts; (7) Update Voquezna quantity limits and extend NERD approval duration to 6 months in Essential and Complete plans; (8) Update all testosterone products (Androgel, Axiron, Azmiro, Delatestryl, Depo-Testosterone, First-Testosterone, Fortesta, Jatenzo, Kyzatrex, Natesto, Testim, Testopel, Testosterone, Tlando, Undecatrex, Vogelxo, Xyosted) coverage language from 'gender dysphoria' to 'gender-affirming care' per WPATH guidelines in Standard and Complete plans; (9) Update Zoryve cream 0.3% age requirements per updated labeling in Standard and Complete plans; (10) Add prostate cancer to Truqap coverage indications in Standard, Metallic, and Essential plans; (11) Add Cligavyx to fulvestrant products program in Metallic and Essential plans. Provider and clinical staff should be notified of coverage changes. Update prior authorization templates and decision trees. Failure to implement these changes will result in claim denials and coverage issues for affected medications.