CommercialCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Rheumatology, Oncology, Endocrinology +1 more·Medical Policy
Effective date
Oct 15, 2025
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated coverage criteria for four medications and made genicular artery embolization non-covered. Key changes include new juvenile arthritis coverage for Cimzia, relaxed bone density requirements for Evenity, expanded cancer indications for Rybrevant and Yervoy, and elimination of coverage for genicular artery embolization for knee pain.
Action Required
By October 15, 2025: Update prior authorization requirements and coverage criteria for Certolizumab pegol (Cimzia) to include juvenile idiopathic arthritis patients age 2+ weighing 10kg+. Update Romosozumab-aqqg (Evenity) criteria to allow T-scores ≤ -2.5 instead of -3.0. Add continuation therapy documentation requirements for Amivantamab-vmjw (Rybrevant) and Ipilimumab (Yervoy) showing disease stabilization or tumor reduction. Stop coverage for genicular artery embolization procedures effective November 15, 2025.