12/16/2025
BCBSM/BCN
Publications - Important Articles to Note!
December 2025 Issue Available HERE.
We’re making changes to preferred drug designations under medical benefits for most members
Formulary changes affect Medicare Advantage members for 2026
We’re changing how we manage Entyvio for most PPO, HMO commercial members, starting Jan. 1
We’re changing how we manage Simponi Aria for most commercial members, starting Feb. 1
MESSA offering a new medical plan as of Jan. 1, 2026
November/December Issue Available HERE.
Important Pages to Note:
Page 3 BCN is making changes to group and individual health plans in 2026
Page 22 Change to copay and coinsurance for oral chemotherapy for some commercial members, starting Jan. 1
Page 29 Select requesting provider when submitting prior authorization requests in Medical and Pharmacy Drug PA Portal
Page 34 Osenvelt and Stoboclo will be the preferred denosumab biosimilar products for most commercial members, starting Dec. 15
Page 38 Include NDC codes on claims for gene and cellular therapy drugs for commercial members for faster and more accurate processing
Page 40 We're changing how we cover Rinvoq, Rinvoq LQ and Skyrizi on our Custom Select Drug List, starting Jan. 1
Page 41 We’re making some changes to how we cover some medications on the drug lists associated with our prescription drug plans, starting Jan. 1
Page 58 Urgent appeals are treated as member appeals, accepted only when member’s situation is urgent
Page 59 Changes to prior authorization requirements for select services managed by BCN