Pharmacy & Specialty Drugs policy updates
Track new and updated Pharmacy & Specialty Drugs policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Wegovy (semaglutide) — Supplemental Indications (cardiovascular risk reduction and MASH) | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 15, 2026 |
| Formulary Medical Necessity Program | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2026 |
| Colony Stimulating Factors | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 6, 2026 |
| Colony Stimulating Factors | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 6, 2026 |
| Formulary Medical Necessity Program | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 3, 2026 |
| ADHD and Narcolepsy Prior Authorization for Stimulants and Wakefulness Agents | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | May 29, 2026 |
| Cimzia (certolizumab pegol) — prior authorization and coverage criteria | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | May 29, 2026 |
| Federal Employee Program (FEP) Medical Prior Authorization Drug List | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | Apr 9, 2026 |
| Erythropoiesis-stimulating agents (ESAs) coverage | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | Apr 1, 2026 |
| Neuromuscular Blocking Agents (botulinum toxin products) | Blue Cross Blue Shield - Iowa | Clinical | Pharmacy & Specialty Drugs | Modified | Mar 28, 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.
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.