All PlansPrior AuthHigh impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·Pain Management, Orthopedics, General Surgery +3 more·Pharmacy
Effective date
Oct 1, 2026
We identified it
Jun 19, 2026
Summary
New criteria and limits have been added for Tapentadol ER formulary coverage, and a 7-day duration limit with MME (Morphine Milligram Equivalent) limits has been implemented for immediate-release opioids in acute pain treatment. These changes affect the Metallic formulary tier and update opioid prescribing guidelines.
Action Required
Before October 1, 2026: Billing team must update prior authorization workflows for Tapentadol ER prescriptions to include new criteria requirements. Providers must be trained on the 7-day limit for immediate-release opioids in acute pain cases and MME calculation requirements. Update EMR templates to include MME tracking and duration limits for opioid prescriptions. Claims may be denied if new criteria and limits are not followed.