BlueSpeak September 2026: Pharmacy Policy Updates

By September 15, 2026: Billing and clinical teams must identify all patients currently prescribed Fingolimod 0.5mg or Everolimus (any listed strength) under Blue KC commercial, ACA QHP, small group, ACA JAA, and Medicare Advantage plans. Work with prescribers to ensure all active prescriptions for these medications are transferred to Lumicera Specialty Pharmacy before October 1, 2026. Verify that existing prior authorizations (PAs) remain valid and will continue through their approved timeframe—no new PAs are needed if already in place. Update pharmacy vendor records in billing system to route these medications exclusively to Lumicera. Communicate with members via letter (Blue KC will provide) explaining the transition and provide Lumicera contact information. By October 1, 2026: Reject or redirect any claims for Fingolimod or Everolimus from non-Lumicera pharmacies. For new Loargys prescriptions, ensure prior authorization is obtained; bill under appropriate HCPCS code for IV or SQ administration. Failure to transition to Lumicera may result in claim denials and member access delays.