CommercialPrior AuthHigh impact
Medical Policy and Coding Updates - March 2020
Premera Blue Cross·WA · Oncology, Neurology, Rheumatology +5 more·Medical Policy
Effective date
Jun 5, 2020
We identified it
Jun 18, 2026
Summary
Multiple drug and treatment policies updated with new medications, biosimilar preferences, and prior authorization requirements. Key changes include new biosimilar hierarchies for cancer drugs, updated age criteria for asthma medications, and new prior authorization requirements for multiple sclerosis treatments.
Action Required
Immediately: Update billing system to require prior authorization for J2350 (Ocrevus). By March 5, 2020: Update prior authorization requirements for codes A6460, A6461, Q4220, Q4222, Q4226 for bio-engineered skin substitutes. Update sacral nerve stimulation codes 64585, 64590, 64595 from investigational to medical necessity review. Remove prior authorization requirements for dry needling codes 20560, 20561. Billing team must verify biosimilar hierarchies when billing for cancer treatments - use first-line biosimilars before second-line options to avoid denials.