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Arkansas Blue Cross Blue ShieldCommercial · Prior Auth · Medical Policy · Oncology, Hematology, Rheumatology +2 moreHigh impact

Policy Criteria Change

Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
Jun 19, 2026

Summary

Effective April 1, 2026, Walmart insurance will require prior authorization for all Bevacizumab, Infliximab, and Rituximab products (brand and biosimilars) across oncologic and non-oncologic indications. The policy establishes preferred biosimilar products (Mvasi, Zirabev, Avsola, Inflectra, Truxima, Riabni) that must be requested first, with non-preferred products (including Avastin, Remicade, Rituxan) requiring documented adverse events and FDA MedWatch reporting for exceptions.

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What to do

by Apr 1, 2026 · 4 steps
01Billing team must update prior authorization systems to require approval for all Bevacizumab, Infliximab, and Rituximab products.
02Update encounter forms and EMR templates to indicate preferred biosimilars (Mvasi, Zirabev, Avsola, Inflectra, Truxima, Riabni) must be requested first.
03Train providers on new exception criteria requiring FDA MedWatch reporting for non-preferred products.
04Claims submitted without prior authorization will result in administrative denials.

Codes mentioned

Q5107Q5118J9035Q5126Q5129J9999Q5121Q5103J1745Q5109Q5104Q5123Q5115J9310J9312Q5119

Original notice

Policy Criteria Change
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Related changes

See all Arkansas Blue Cross Blue Shield changes →
Policy Criteria ChangeMediumEffective Apr 15, 2026 · Medical PolicyPolicy Criteria ChangeHighEffective Oct 28, 2026 · Medical PolicyPolicy Criteria ChangeHighEffective Nov 15, 2026 · Medical PolicyPolicy Criteria ChangeMediumEffective Nov 15, 2026 · Medical PolicyBrowse every Arkansas Blue Cross Blue Shield change in the policy list

Related policy hubs

Arkansas Blue Cross Blue Shield policiesOncologyHematologyRheumatologyGastroenterologyOphthalmologyCode Q5107Code Q5118Code J9035Code Q5126Code Q5129Code J9999Code Q5121Code Q5103Code J1745Code Q5109Code Q5104Code Q5123Code Q5115Code J9310Code J9312Code Q5119

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