CommercialCoverageHigh impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Oncology, Hematology·Pharmacy
Effective date
May 2, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross has updated drug policy criteria for multiple oncology and specialty medications, with changes to coverage requirements, clinical indications, and treatment combinations. The changes affect formulary coverage for cancer treatments like Pomalyst, Revlimid, and various targeted therapy drugs, with most changes effective May 2, 2026.
Action Required
By May 2, 2026: Clinical and billing teams must review updated prior authorization criteria for oncology drugs including Pomalyst, Revlimid, lenalidomide, Zirabev, Braftovi, Mektovi, Tafinlar, Mekinist, bortezomib, and Ninlaro. Update prior authorization forms and clinical documentation requirements to align with new NCCN guidelines and disease-specific criteria. Ensure providers document appropriate disease staging, prior treatment history, and combination therapy indications as specified in the updated criteria to prevent claim denials.