CommercialPrior AuthMedium impact
Pharmacy Medical Policy Updates
Blue Cross Blue Shield of Kansas·KS · Endocrinology, Oncology, Cardiology +4 more·Pharmacy
Effective date
Nov 1, 2023
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Kansas is updating multiple pharmacy medical policies with staggered effective dates starting November 1, 2023. The updates affect various medication categories including diabetes management (CGM, insulin pumps), specialty drugs (Jynarque, Rystiggo, Tezspire), oncology medications, and other therapeutic areas managed through their pharmacy benefit manager Prime Therapeutics.
Action Required
By November 1, 2023: Billing team must review updated pharmacy medical policies for affected medications on the BCBSKS prior authorization website (https://www.bcbsks.com/providers/precertification-prior-authorization). Check specific medication lists for prior authorization requirements for Jynarque (effective Nov 1), and prepare for December 1, 2023 updates affecting Rystiggo, CGM systems, insulin pumps, Tezspire, oncology drugs, PCSK9 inhibitors, and other listed medications. Contact BCBSKS provider representative for clarification on specific requirements.