CommercialCoverageHigh impact
Medical Policy and Coding Updates - August 2020
Premera Blue Cross·WA · Oncology, Endocrinology, OB-GYN +5 more·Medical Policy
Effective date
Aug 1, 2020
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple drug policies and medical policies with new covered medications, site of service reviews, and revised coverage criteria. Key changes include new oncology drugs, fertility treatments, imaging guidelines, and updated medical necessity criteria across multiple therapeutic areas effective between August 1-October 2, 2020.
Action Required
By October 2, 2020: Billing team must update prior authorization requirements for new drugs including Kyprolis, Velcade, fertility medications (Bravelle, Follistim AQ, Pregnyl), and oncology drugs (Jevtana, Xofigo). Update billing system to reflect site of service reviews for Avsola, Ruxience. Review and implement new medical necessity criteria for IL-5 inhibitors, BRAF inhibitors, and immune checkpoint inhibitors. Train staff on updated AIM Specialty Health radiology guidelines for chest imaging, oncologic imaging, and sleep disorder management effective August 16, 2020.