Summary
BlueCross BlueShield of Tennessee is implementing a new coverage policy for Reslizumab (Cinqair®) for severe eosinophilic asthma in adults 18+. The policy establishes prior authorization requirements, clinical criteria (eosinophil count ≥400 cells/mcL or systemic corticosteroid dependence plus uncontrolled asthma), prescriber specialty restrictions (allergist/immunologist or pulmonologist only), and a dosing limit of 3mg/kg IV every 4 weeks. Initial authorizations are granted for 6 months, with continuation authorizations for 12 months if asthma control improves.
Get alerts when payers change rules like this one
We check BCBS Tennessee and other payers every day and email you when a change matches your specialty and state.
Get BCBS Tennessee alertsPolicy Monitoring is free. No card required.
What to do
Action · 8 steps
01Before December 1, 2026.
02Billing team must update prior authorization workflow in billing system to require prior auth for Cinqair (HCPCS J2786) for all asthma claims.
03Create prior authorization checklist requiring: baseline blood eosinophil count ≥400 cells/mcL OR systemic corticosteroid dependence, evidence of uncontrolled asthma within past 12 months (≥2 exacerbations requiring oral/injectable corticosteroids, OR ≥1 hospitalization/ED visit, OR poor symptom control), and documentation of high-dose ICS + additional controller at optimized doses.
04Providers must add prescriber specialty validation to encounter forms—only allergist/immunologist or pulmonologist orders allowed; route denials if prescribed by other specialists.
05Billing staff must enforce quantity limit of 3mg/kg every 4 weeks in billing system to prevent claim denials.
06For continuation of therapy after initial 6-month period, require documentation of improved asthma control (reduced symptom/exacerbation frequency, reduced/discontinued oral corticosteroid dose).
07Failure to obtain prior authorization or meet clinical criteria will result in claim denials.
08Update clinical staff and prior auth team on new requirements.
Codes mentioned
J2786
Original notice
Reslizumab (Cinqair®)
bcbst.com · Always check the source before changing claims.