Immunology/Rheumatology policy updates
Track new and updated Immunology/Rheumatology policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Guselkumab (Tremfya) — coverage criteria for IV and SC administration | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Jul 1, 2026 |
| Certolizumab pegol (Cimzia) — Coverage Criteria | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Jul 1, 2026 |
| Canakinumab (Ilaris) subcutaneous injection — Medical Necessity and Prior Authorization Criteria | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Jul 1, 2026 |
| Infliximab (Remicade) and infliximab biosimilars notification policy | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Jul 1, 2026 |
| Rituximab (Rituxan) and Rituximab Biosimilars for the Treatment of Non-Oncologic Indications | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Jul 1, 2026 |
| Tocilizumab (Actemra) and Tocilizumab Biosimilars coverage | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Jul 1, 2026 |
| Immunoglobulin therapy (IVIG/SCIG) notification policy | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Apr 1, 2026 |
| Allogeneic Processed Thymus Tissue (Rethymic) — Coverage Criteria | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Apr 1, 2026 |
| Rituximab for the Treatment of Rheumatoid Arthritis - Coverage Criteria | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Jan 1, 2026 |
| Inebilizumab-cdon (Uplizna) — Coverage Criteria (Intravenous Infusion) | Blue Cross Blue Shield - North Carolina | Clinical | Immunology/Rheumatology | Modified | Jan 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.