CommercialCoverageMedium impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Endocrinology, Hematology, Oncology +2 more·Pharmacy
Effective date
Apr 19, 2026
We identified it
Jun 19, 2026
Summary
Multiple drug policy criteria changes affecting various medications including octreotide products, Hemlibra, sodium phenylbutyrate, and others. Key changes include relaxed acromegaly treatment requirements, new coverage additions, and retirement of several antiemetic and PPI criteria.
Action Required
Before April 19, 2026: Billing team must update prior authorization processes for affected medications. Update criteria for octreotide products, somatuline depot, and Somavert to reflect that surgery/radiotherapy must not be an option (not just clinical reason to avoid). Add Hemlibra combination restrictions with Qfitlia. Update sodium phenylbutyrate age requirements to 1 year or older and weight to 7kg minimum. Prepare for retirement of 5-HT3 antiemetics, Anzemet, Granisetron, Ondansetron, PPIs, and Tretinoins criteria by July 1, 2026.