CommercialCoverageHigh impact
Medical Policy and Coding Updates - May 2023
Premera Blue Cross·WA · Oncology, Endocrinology, Gastroenterology +5 more·Medical Policy
Effective date
May 1, 2023
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple medical and pharmacy policies effective May 1, 2023, with additional drug updates taking effect in July and August 2023. Key changes include expanded bariatric surgery coverage for diabetic patients with class I obesity, new drug additions across oncology and rare diseases, updated prior authorization requirements for various medications, and policy renumbering for cochlear implants and aortic valve procedures.
Action Required
By May 1, 2023: Billing team must update prior authorization workflows for newly added drugs including Leqembi, Daxxify, Hemgenix, and various rare disease medications. Update bariatric surgery criteria to include T2 diabetic patients with class I obesity. Review and update encounter forms with new policy numbers for cochlear implants (7.01.586) and transcatheter aortic valve implantation (7.01.132). Verify coverage criteria for botulinum toxin treatments and oncology maintenance therapies. Contact Premera for specific prior authorization requirements for each newly added medication.