CommercialPrior AuthHigh impact
AB2026-06-004 Medical policies
Capital Blue Cross·Oncology, Endocrinology, Gastroenterology +7 more·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross has updated medical policies with new prior authorization requirements for two specialty injectable drugs (Loargys and Exdensur) effective July 1, 2026, and revised policies for 40+ specialty injectable drugs effective August 1, 2026. Multiple medical policies have also removed specific procedure codes that will now be managed by EviCore.
Action Required
By July 1, 2026: Update billing system to require prior authorization for codes J3590 and C9399 when billing for new drugs Loargys and Exdensur. Submit authorization requests through Prime MPS GatewayPA Portal at GatewayPA.com or call 800.424.1710 for urgent requests. By August 1, 2026: Review updated medical specialty injectable policies for 40+ revised drugs and verify authorization periods have changed for some medications. Remove multiple procedure codes from internal billing systems as they will now be managed by EviCore instead of Capital Blue Cross.