BlueSpeak September 2026: Drug Waste Policy Edit Effective January 1, 2027

By December 31, 2026: Billing team must update claims processing system and provider education materials to enforce JW and JZ modifier requirements for all SDV pharmaceutical claims. Specific requirements: (1) Implement system validation to require JW modifier for wasted drug amounts reported on separate claim lines; (2) Implement system validation to require JZ modifier when zero waste occurs and actual dose is less than billing unit; (3) Configure system to reject claims with JW modifier when actual dose is less than billing unit (JZ modifier must be used instead); (4) Create provider-facing billing guidance documents explaining vial size optimization (e.g., use two 20-unit vials instead of one 100-unit vial when possible); (5) Update encounter form templates and EMR documentation requirements to capture: amount administered, date, time, amount discarded, and reason for waste. Providers must document these details in member medical records. Affected specialties and facilities that administer SDV drugs must be notified of requirements. Failure to comply will result in claim denials and overpayment recoupment on non-compliant claims submitted to Blue KC.