CommercialPrior AuthMedium impact
Drug Policy Criteria Change
Arkansas Blue Cross Blue Shield·Neurology, Oncology, Endocrinology +1 more·Pharmacy
Effective date
Feb 15, 2026
We identified it
Jun 19, 2026
Summary
This policy update changes criteria for multiple specialty medications including Parkinson's drugs, cancer treatments, and consolidates all Multiple Sclerosis drug policies into a single guideline. Key changes include longer approval durations (6 to 12 months for several drugs), new biosimilar options, updated prescriber specialty requirements, and retirement of individual MS drug policies in favor of consolidated criteria.
Action Required
By February 15, 2026: Update prior authorization systems to reflect new approval durations for Nuplazid, Apokyn, and Inbrija (now 12 months instead of 6). Add prescriber specialty requirements for Crysvita, Strensiq, and Vanrafia. Update formulary systems to include new biosimilars for Stelara. By February 16, 2026: Replace individual MS drug authorization forms with new consolidated Multiple Sclerosis products SGM 7136-A criteria for all MS medications including Tecfidera, Ocrevus, Kesimpta, and others.