QualChoice policy updates
Track new and updated QualChoice policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Insulin icodec-abae (Awiqli) coverage criteria | QualChoice | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 1, 2026 |
| Difamilast (Adquey) topical for atopic dermatitis | QualChoice | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 1, 2026 |
| Relacorilant (Lifyorli) coverage for platinum‑resistant ovarian, fallopian tube, or primary peritoneal cancer | QualChoice | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 1, 2026 |
| Clinical Policy: Tradipitant (Nereus) | QualChoice | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 1, 2026 |
| Abaloparatide (Tymlos) coverage | QualChoice | Clinical | Endocrinology | Modified | Jun 1, 2026 |
| Clinical Policy: Teriparatide (Forteo, Bonsity) | QualChoice | Clinical | Endocrinology | Modified | Jun 1, 2026 |
| Sibeprenlimab-szsi (Voyxact) for IgA Nephropathy | QualChoice | Clinical | Nephrology | Modified | Jun 1, 2026 |
| Clinical Policy: Experimental Technologies | QualChoice | Clinical | Other | Modified | May 1, 2026 |
| Marnetegragene autotemcel (Kresladi) gene therapy | QualChoice | Clinical | Pharmacy & Specialty Drugs | Modified | Mar 26, 2026 |
| Etripamil (Cardamyst) for PSVT | QualChoice | Clinical | Cardiology | Modified | Mar 1, 2026 |
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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.