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

Changes to preferred drug designations, other requirements for Medicare Advantage members start in November, January

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

Use Medical and Pharmacy Drug PA Portal to submit prior authorization requests for pharmacy benefit drugs

Be sure to include ordering or referring physician’s NPI number when submitting Medicare Advantage PPO claims

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