02/17/2026
Blue Care Network
Publications - Important Articles to Note
January/February Issue Available HERE
ARTICLES OF INTEREST
Page 5 New riders cover telehealth services prior to meeting deductible
Page 7 Blue Care Network fee schedule update reminder
Page 9 Learn more about changes to prior authorization process for post-acute care
Page 11 Formulary changes affect Medicare Advantage members for 2026
Page 15 Medical policy updates
Page 19 BCN behavioral health fee schedule changes
Page 20 Pharmacy news roundup
Page 22 Use the Medical and Pharmacy Drug PA Portal to submit prior authorization requests for pharmacy benefit drugs
Page 24 Changes to preferred drug designations, other requirements for Medicare Advantage members
Page 26 We’re making changes to preferred drug designations under medical benefits for most members
Page 32 Fensolvi, Triptodur to require prior authorization, step therapy requirements for most commercial members
Page 33 Bkemv to have a site-of-care requirement for most commercial members
Page 35 We’re changing how we manage Entyvio for most PPO, HMO commercial members
Page 36 We’re changing how we manage Simponi Aria for most commercial members
Page 37 Situations when you can submit medical records through Availity Essentials
Page 38 Coding corner: Properly documenting diabetes mellitus; Chronic kidney disease
Page 41 Blue Cross will no longer separately pay providers for these items and services for our commercial members
Page 43 Reminder: Providers responsible for cost of external second-level peer review cases with upheld decisions