L1846 Insurance Policy Changes

AB2026-02-003 Medical policies

Capital Blue Cross has updated multiple medical policies effective March 1, 2026 and April 1, 2026, including new prior authorization requirements for medical specialty injectables (delegated to Prime MPS), new PA requirement for Blenrep drug (J9999 code), and revised criteria for numerous injectable medications, medical devices, and diagnostic procedures. Medical specialty injectable PA requests must now be submitted through Prime MPS GatewayPA Portal instead of Capital Blue Cross directly.