Pharmacy & Specialty Drugs policy updates
Track new and updated Pharmacy & Specialty Drugs policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Gonadotropin Releasing Hormone (GnRH) Therapy Notification | Blue Cross Blue Shield - North Carolina | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Site-of-Care Drug List | Blue Cross Blue Shield - North Carolina | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Testosterone Cypionate (Azmiro) - Notification | Blue Cross Blue Shield - North Carolina | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| CAR-T Therapy "Notification" (PDF) Opens in a New Tab. | Blue Cross Blue Shield - North Carolina | Clinical | Pharmacy & Specialty Drugs | Modified | Apr 1, 2026 |
| Delandistrogene moxeparvovec-rokl (Elevidys) — Notification | Blue Cross Blue Shield - North Carolina | Clinical | Pharmacy & Specialty Drugs | Modified | Apr 1, 2026 |
| Gonadotropin Releasing Hormone (GnRH) therapy — coverage and notification | Blue Cross Blue Shield - North Carolina | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Pegcetacoplan (Empaveli) — Coverage Criteria for Subcutaneous Infusion | Blue Cross Blue Shield - North Carolina | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| HSA Preventive Drug List | Blue Cross Blue Shield - North Carolina | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2025 |
| Non-Formulary Exception Criteria for Approval | Blue Cross Blue Shield - North Carolina | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2025 |
| Non-Formulary Exception Criteria for Approval (Medicare Part D) | Blue Cross Blue Shield - North Carolina | 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.
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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.