All PlansPrior AuthMedium impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·Pharmacy·Pharmacy
Effective date
Oct 1, 2026
We identified it
Aug 7, 2026
Summary
Three drugs (Brinsupri, Hernexeos, and Modeyso) have new coverage criteria effective October 1, 2026. The policy document does not specify what the new criteria are, only that criteria have changed. Billing and clinical teams must obtain the detailed criteria from the payer to implement prior authorization or coverage requirements.
Action Required
By September 15, 2026: Billing team and providers must contact the insurance carrier to obtain the complete new criteria for Brinsupri, Hernexeos, and Modeyso. Once criteria are received, update billing system and EMR to implement any required prior authorization workflows. Pharmacy staff should review new criteria and communicate requirements to prescribing providers. Failure to implement new criteria by the effective date may result in claim denials or payment delays.