CommercialCoverageMedium impact
Medical Policy and Coding Updates - May 2024
Premera Blue Cross·WA · Cardiology, Gastroenterology, Neurology +5 more·Medical Policy
Effective date
May 1, 2024
We identified it
Jun 18, 2026
Summary
Premera Blue Cross has updated multiple medical and pharmacy policies for Washington state, with various effective dates from May 1 to August 2, 2024. Key changes include new drugs added for coverage (including Alzheimer's treatments and rare disease medications), updated medical necessity criteria for various treatments, and revised genetic testing guidelines.
Action Required
By August 2, 2024: Billing teams must review and update prior authorization requirements for newly added medications including Leqembi (lecanemab-irmb) for Alzheimer's disease, Fabhalta (iptacopan) for PNH, and updated Dupixent criteria for patients as young as 1 year old with eosinophilic esophagitis. Update billing systems to reflect new medical necessity criteria for transcatheter aortic valve implantation (removal of left ventricular ejection fraction >20% requirement) and upper GI endoscopy coverage for family history indications. Verify genetic testing coverage updates through Carelon guidelines effective June 30, 2024.