All PlansCoverageMedium impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·Endocrinology, Rheumatology, Nephrology +2 more·Pharmacy
Effective date
Jul 15, 2026
We identified it
Jun 19, 2026
Summary
Multiple drug policy criteria changes effective July 15, 2026, including new criteria for Spravato and Actimmune, expanded Rinvoq coverage for Giant Cell Arteritis, relaxed requirements for continuous glucose monitors, and updated coverage policies for Empaveli and Acthar medications across Standard and Metallic formularies.
Action Required
By July 15, 2026: Billing team must update prior authorization workflows for affected drugs including Spravato, Actimmune, Rinvoq (for Giant Cell Arteritis), continuous glucose monitors (remove insulin pump requirement), Empaveli (add C3G coverage), and Acthar Gel. Update system criteria to reflect new coverage requirements and remove outdated insulin pump requirements for CGM coverage. Train staff on new formulary distinctions between Standard and Metallic plans.