CommercialCoverageHigh impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Oncology, Hematology·Medical Policy
Effective date
Jun 15, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated coverage criteria for four oncology medications: Teclistamab-cqyv (Tecvayli) for multiple myeloma, Nab-Paclitaxel (Abraxane) for various cancers, Irinotecan Liposomal (Onivyde) for pancreatic/ampullary cancers, and Ado-Trastuzumab Emtansine (Kadcyla) for HER2-positive malignancies. These updates include new FDA-labeled and off-label indication criteria that will affect prior authorization requirements.
Action Required
Before June 15, 2026: Oncology billing teams must review and update prior authorization workflows for Tecvayli, Abraxane, Onivyde, and Kadcyla claims. Update system edits to verify patients meet new coverage criteria including specific prior therapy requirements, ECOG performance status documentation, and combination therapy protocols. Providers must document compliance with updated criteria to avoid claim denials.