CommercialPrior AuthHigh impact
Pharmacy Medical Policy Updates
Blue Cross Blue Shield of Kansas·KS · Oncology, Rheumatology, Endocrinology +5 more·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSKS updated pharmacy medical policies for 20+ specialty medications effective January 1, 2025, including biologic immunomodulators, oncology drugs, and treatments for hereditary angioedema, osteoporosis, and other conditions. These updates likely affect prior authorization requirements and coverage criteria for high-cost specialty pharmaceuticals.
Action Required
By January 1, 2025: Billing team and providers must review updated pharmacy medical policies for 20+ specialty medications including Efgartigimod, Empaveli, Enspryng, Soliris, Ultomiris, and others listed. Check BCBSKS prior authorization requirements at https://www.bcbsks.com/providers/precertification-prior-authorization before prescribing or billing for these medications. Update prior authorization workflows and inform prescribing providers of potential coverage changes to prevent claim denials.