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.
Get alerts when payers change rules like this one
We check Arkansas Blue Cross Blue Shield and other payers every day and email you when a change matches your specialty and state.
Get Arkansas Blue Cross Blue Shield alertsPolicy Monitoring is free. No card required.
What to do
Action · 4 steps
01Before 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.
02Update 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.
03Update Denosumab authorization renewal requirements to include BMD documentation after 24+ months of therapy.
04Review encounter forms to ensure proper code selection based on preferred vs non-preferred product lists.
Codes mentioned
Q9996Q9997Q9998Q5100Q5098Q9999J3357J3358Q5099Q5164Q5137Q5138
Original notice
Policy Criteria Change
assets.contentstack.io · Always check the source before changing claims.
Related changes
See all Arkansas Blue Cross Blue Shield changes →Provider Criteria ChangeMediumEffective Nov 11, 2026 · Medical PolicyPolicy Criteria ChangeHighEffective Nov 15, 2026 · Medical PolicyPolicy Criteria ChangeHighEffective Oct 28, 2026 · Medical PolicyPolicy Criteria ChangeMediumEffective Nov 15, 2026 · Medical PolicyBrowse every Arkansas Blue Cross Blue Shield change in the policy list