CommercialPrior AuthHigh impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·Oncology, Hematology, Rheumatology +3 more·Pharmacy
Effective date
Jun 28, 2026
We identified it
Jun 19, 2026
Summary
Multiple drug coverage criteria changes affecting various medications including new coverage additions, updated age requirements, and enhanced prior authorization requirements. Changes span from June 2026 through January 2027 with different formulary tiers affected.
Action Required
By June 28, 2026: Billing team must update prior authorization requirements for multiple medications including Inqovi for acute myeloid leukemia, Enhertu for early stage HER2-positive breast cancer, and expanded Cosentyx coverage for pediatric ankylosing spondylitis patients 12+ years. By August 15, 2026: Implement enhanced documentation requirements for Lumryz, Rinvoq, and sodium oxybate requiring sleep lab confirmation with specific MSLT parameters and clinical severity thresholds. Update system to flag concurrent use restrictions for Cibinqo with Dupixent/Ebglyss/Nemluvio and ensure specialist attestation requirements. Failure to meet new criteria will result in claim denials.