CommercialCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Neurology, Pediatrics, Nephrology +2 more·Medical Policy
Effective date
Jun 3, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated coverage criteria for Zolgensma (onasemnogene abeparvovec-xioi) gene therapy for spinal muscular atrophy with 7 specific requirements including age limits, genetic testing, and prescriber qualifications. Additionally, 6 older medical policies will be archived on June 3, 2026.
Action Required
By June 3, 2026: Review patient cases for Zolgensma therapy to ensure all 7 updated criteria are documented including age under 2 years, genetic testing for SMN1 mutations, SMN2 gene copies, disease severity, AAV9 antibody titers, no prior gene therapy, and neurologist prescription. Update prior authorization forms and clinical documentation templates to reflect new requirements. For archived policies (Antithrombin III, Interferon Gamma-1B, Intradialytic Parenteral Nutrition, Strontium 89, Tumor Vaccines, Nesiritide), verify alternative coverage policies are in place before effective date.