CommercialCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Cardiology, Endocrinology, Internal Medicine +1 more·Medical Policy
Effective date
Jul 29, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated coverage criteria for Inclisiran (Leqvio) cholesterol medication, requiring PCSK9 inhibitor failure and specific LDL-C thresholds. Ambulatory blood pressure monitoring criteria were also revised to limit coverage to one-time use for confirming white coat hypertension.
Action Required
By July 29, 2026: Billing team must update prior authorization protocols for Inclisiran prescriptions to include documentation of PCSK9 inhibitor failure, specific LDL-C levels, and ASCVD history. Update ambulatory blood pressure monitoring orders to ensure single-use justification for white coat hypertension diagnosis. Claims without proper documentation will be denied.