CommercialPrior AuthHigh impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Oncology, Hematology, Gastroenterology +2 more·Medical Policy
Effective date
Aug 19, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated authorization renewal criteria for three medications: Tagraxofusp-erzs (Elzonris), Ustekinumab (Stelara) including preferred/non-preferred product lists and expanded age criteria for Crohn's disease from 18+ to 2+ years, and Denosumab (Xgeva/Prolia) with updated off-label indications. All changes include new preferred product formulations with specific HCPCS codes.
Action Required
Before August 19, 2026: Billing team must update prior authorization systems to reflect new continuation criteria for Tagraxofusp-erzs requiring documentation of condition improvement, manageable side effects, and specific lab values. Update Ustekinumab billing to use preferred HCPCS codes (Q9996, Q9997, Q9998, Q5100) when available and expand Crohn's disease coverage to patients as young as 2 years old. Update Denosumab authorization renewal requirements to include BMD documentation after 24+ months of therapy. Review encounter forms to ensure proper code selection based on preferred vs non-preferred product lists.