All PlansCoverageMedium impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·Oncology, Pharmacy·Pharmacy
We identified it
Aug 15, 2026
Summary
This policy expands coverage for two oncology drugs: Ibrance now covers HR-positive, HER2-positive breast cancer and combination therapy with Revtorpyk (gedatolisib) effective 09/05/2026; Cavhanza is added to the nilotinib class with new mutation criteria (KIT and/or PDGFRA positive) for gastrointestinal stromal tumors effective 10/21/2026. Billing teams must update prior authorization requirements and coverage criteria for these drugs.
Action Required
By 09/05/2026: Billing and prior authorization teams must update pharmacy benefit system to reflect expanded Ibrance coverage for HR-positive, HER2-positive locally advanced, recurrent unresectable, or metastatic breast cancer, and for combination use with Revtorpyk. Update prior auth templates and denial protocols. By 10/21/2026: Update system to add Cavhanza to coverage criteria and implement requirement that gastrointestinal stromal tumor claims must document KIT and/or PDGFRA mutation positivity per NCCN guidelines. Train prior auth staff on new mutation requirement to prevent denials. Failure to implement these changes will result in claim denials and prior authorization processing errors.