Pharmacy & Specialty Drugs policy updates
Track new and updated Pharmacy & Specialty Drugs policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Capital Blue Cross Advantage Formulary | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Children's Health Insurance Program (CHIP) Drug Formulary — Coverage Criteria | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Medicare Part B Step Therapy for outpatient drugs | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Genotype‑Guided Tamoxifen Treatment (CYP2D6) | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Dec 1, 2025 |
| Off‑Label Use of Medications and Other Interventions | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Oct 1, 2025 |
| Orphan Drugs and Humanitarian Use Device (HUD) | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2025 |
| OLINVYK (oliceridine) | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2025 |
| CHIP opioid drug list and quantity limits | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2025 |
| Elite Opioid drug list update | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2025 |
| Advantage - Opioid drug list update | Capital Bluecross | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2025 |
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.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
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.