Pharmacy & Specialty Drugs policy updates
Track new and updated Pharmacy & Specialty Drugs policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Inclisiran (Leqvio®) | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Sep 1, 2026 |
| Secukinumab (Cosentyx) — Coverage Criteria | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Sep 1, 2026 |
| Bevacizumab Products (Avastin and listed biosimilars) Coverage and Authorization | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 31, 2026 |
| Lanreotide (Somatuline® Depot) coverage | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 31, 2026 |
| Pasireotide (Signifor LAR) — Coverage Criteria | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 31, 2026 |
| Octreotide (Sandostatin LAR) injectable suspension — Coverage Criteria | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 31, 2026 |
| Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta) | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 30, 2026 |
| Opdivo Qvantig (nivolumab biosimilar) — Coverage Criteria | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 30, 2026 |
| Ustekinumab Products (Stelara and biosimilars) — Coverage and Prior Authorization Criteria | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 30, 2026 |
| Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta) Coverage Criteria | Blue Cross Blue Shield - Tennessee | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 2, 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.