CommercialCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Ophthalmology, Endocrinology, Urology +2 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated multiple medical policies effective January 1, 2026, including expanded coverage for eye treatments (Iluvien for uveitis, Ranibizumab for diabetic conditions), addition of new self-administered medications, and new continuation therapy requirements for testosterone and rituximab treatments. One policy for Cabotegravir ER will be archived.
Action Required
Before January 1, 2026: Billing team must update coding for Omalizumab-igec to use new HCPCS code Q5154 instead of previous code. Review and update prior authorization processes for Iluvien (uveitis), Ranibizumab/Susvimo (diabetic eye conditions), testosterone therapy, and rituximab to include new continuation therapy criteria requiring objective benefit documentation. Stop processing claims for Cabotegravir ER as policy will be archived.