Blue Cross Blue Shield - Massachusetts policy updates
Track new and updated Blue Cross Blue Shield - Massachusetts policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Non-Covered Drug List & Non-Coverary Formulary Exception | Blue Cross Blue Shield - Massachusetts | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2026 |
| Authorization requirements by product | Blue Cross Blue Shield - Massachusetts | Administrative | Preventive Services & Screening | Modified | Jul 1, 2026 |
| Non-Covered Drug List & Non-Covered Formulary Exception | Blue Cross Blue Shield - Massachusetts | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Percutaneous coronary intervention with drug-coated balloon for coronary in-stent restenosis | Blue Cross Blue Shield - Massachusetts | Clinical | Cardiology | Modified | Jun 1, 2026 |
| Spinal fusion and decompression surgery (cervical, thoracic, lumbar) | Blue Cross Blue Shield - Massachusetts | Clinical | Orthopedics/Musculoskeletal | Modified | Jun 1, 2026 |
| Spine Surgery: Cervical, Lumbar and Thoracic Decompression and/or Fusion | Blue Cross Blue Shield - Massachusetts | Clinical | Orthopedics/Musculoskeletal | Modified | Jun 1, 2026 |
| Non-Covered Drug List & Non-Covered Formulary Exception | Blue Cross Blue Shield - Massachusetts | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 1, 2026 |
| Medical Benefit Prior Authorization Medication List | Blue Cross Blue Shield - Massachusetts | Administrative | — | Modified | May 1, 2026 |
| Formulary Exception / Non-covered Drug Prior Authorization | Blue Cross Blue Shield - Massachusetts | Clinical | Pharmacy & Specialty Drugs | Modified | May 1, 2026 |
| Quality Care Dosing (QCD) Guidelines List | Blue Cross Blue Shield - Massachusetts | Clinical | Pharmacy & Specialty Drugs | Modified | May 1, 2026 |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
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Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.