CommercialCoverageHigh impact
Material Amendments and Policy Criteria Changes
Arkansas Blue Cross Blue Shield·AR · Oncology, Hematology·Medical Policy
Effective date
Nov 1, 2025
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated multiple CAR-T cell therapy policies and cancer treatment criteria, adding new coverage for RET testing in colorectal cancer, expanding tisagenlecleucel and lisocabtagene coverage to include off-label indications, and revising nivolumab criteria for colorectal and liver cancers. Several policies removed prior allogeneic stem cell transplant exclusions and added provider assessment guidelines.
Action Required
By November 1, 2025: Oncology billing teams must update prior authorization protocols for CAR-T therapies (tisagenlecleucel, lisocabtagene, idecabtagene, ciltacabtagene) to reflect removed allogeneic stem cell transplant exclusions and new off-label coverage criteria. Update documentation requirements to include provider assessments of organ function, cardiac status, and immunological status for all CAR-T therapies. By December 1, 2025: Implement new coverage criteria for nivolumab in colorectal cancer (MSI-H/dMMR) and hepatocellular carcinoma, ensuring proper documentation of prior PD-1 agent history and continuation criteria.