All PlansCoverageMedium impact
Medical Policy and Coding Updates - January 2020
Premera Blue Cross·WA · Oncology, Hematology, Rheumatology +3 more·Medical Policy
Effective date
Apr 3, 2020
We identified it
Jun 18, 2026
Summary
Multiple drug policy updates affecting biosimilar preferences and coverage criteria across oncology, rheumatology, and other specialties. Several drugs changed from second-line to first-line biosimilars, age criteria updated for some medications, and new drugs added to covered lists.
Action Required
By April 3, 2020: Billing team must update prior authorization protocols to reflect new biosimilar hierarchies - Trazimera and Ruxience are now first-line options requiring no prior treatment failure, while Herzuma, Kanjinti, Ogivri, Ontruzant, and Truxima require documented inadequate response to first-line options. Update drug formulary preferences in billing system and notify providers of new coverage criteria for Nucala (now covers ages 6+ instead of 12+) and newly covered drugs Polivy and genetic testing restrictions.