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Medical Policy and Coding Updates - August 2021
Premera Blue Cross·WA, AK · Oncology, Endocrinology, Orthopedics +3 more·Medical Policy
Effective date
Sep 3, 2021
We identified it
Jun 18, 2026
Summary
Multiple new medical policies and drug formulary updates effective between September and November 2021, including new coverage for oncology drugs, testosterone replacement products, and rare disease treatments. Several procedures including allograft injection for degenerative disc disease and synthetic nerve conduits are now considered investigational/non-covered.
Action Required
Before September 3, 2021: Billing team must update prior authorization requirements for newly added drugs including Abraxane, Arranon, Empliciti, Erwinaze, Halaven, Yondelis, Aralast NP, Glassia, Prolastin-C, Zemaira, and GnRH analogs. Update billing system to flag allograft injections for degenerative disc disease and synthetic nerve conduits as investigational/non-covered effective November 5, 2021. Review AIM Specialty Health imaging guidelines effective September 12, 2021 for advanced imaging prior authorization requirements.