By 12/15/2026: Billing and clinical teams must implement the following changes: (1) Update billing system to flag ALL claims for the non-preferred biologic products listed in policy MPC X.242 (HCPCS codes Q5162, Q5136, Q5157, Q5161, Q5167, Q5171, Q5166, Q5173, Q5159, Q5121, Q5103, Q5104, Q5119, Q5115, Q5123, Q5135, Q5156, Q5117, Q5116, Q5113, Q5146, Q5114, Q5112, and J-codes J0897, J1745, J9312, J9311, J3262, J3590, J9355, J9356) as requiring prior authorization for BCBSNE plans; (2) Establish a prior authorization workflow that REQUIRES providers to document one of the following BEFORE claim submission: patient contraindication to preferred product, documented intolerance, or documented clinical failure; (3) For new-start AND established patients, step therapy requirements apply equally; (4) Update encounter templates and order entry systems to prompt providers to attach step therapy documentation at time of prescribing; (5) Train billing staff to deny and return claims lacking required step therapy documentation. Claims submitted without prior authorization and step therapy evidence will be denied for non-preferred products.