CommercialPrior AuthMedium impact
Medical Policy Updates for July 2026
Blue Cross Blue Shield of Massachusetts·Psychiatry, Neurosurgery, Neurology·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Multiple policy changes effective July 1, 2026: Esketamine nasal spray now requires prior authorization for behavioral health treatment, Tarlov cyst treatments are now considered investigational and non-covered, and two new step therapy requirements for Medicare Part B medications Bildyos and Bilprevda are already in effect.
Action Required
By July 1, 2026: Billing team must update system to require prior authorization for esketamine nasal spray (Spravato) and intravenous ketamine for behavioral health conditions. Stop billing for Tarlov cyst treatments as they are now non-covered. For Medicare Part B: Ensure step therapy protocols are followed - use Step 1 medications before Bilprevda, and use Step 1 and Step 2 medications before Bildyos. Claims will be denied without proper prior authorization or step therapy compliance.