CommercialPrior AuthMedium impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Rheumatology, Endocrinology, Dermatology +1 more·Pharmacy
Effective date
May 10, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated drug policy criteria for three medications: Prolia/biosimilars (bone health drugs) with relaxed requirements for osteoporosis treatment, Cosentyx expanded to pediatric patients 12+ for hidradenitis suppurativa, and Sotyktu added coverage for psoriatic arthritis in adults. The changes primarily affect prior authorization requirements and covered indications.
Action Required
By May 10, 2026: Billing team must update prior authorization workflows for Prolia/biosimilars, Cosentyx, and Sotyktu. Update documentation requirements to reflect relaxed bisphosphonate trial requirements for osteoporosis patients and expanded age criteria for Cosentyx HS treatment. Notify providers that previous injectable therapy failure documentation language has changed to 'inadequate response or intolerance.' Review patient cases that may now qualify under updated criteria.