Medical Policy Update
Blue Cross and Blue Shield of Nebraska (BCBSNE) is proud to work with our provider network to serve your patients, our members. We are updating several medical policies. Please review the changes and effective dates outlined here:
MPC Dec. 15, 2026
New Medical/Pharmacy Policy
Medical Policy: X.242 OptimizeRX
Effective Date: 12/15/2026
Preauthorization Required: YES
Patient must have a contraindication, intolerance, or failure to a preferred product prior to the consideration of another non preferred product.
In summary: step therapy will apply to both new start and established patients on nonpreferred products.
| Preferred Products | Non-Preferred Products |
|
| Denosumab |
Bildyos (Q5162) Bilprevda (Q5162) Jubbonti (Q5136) Osenvelt (Q5157) Stoboclo (Q5157) Wyost (Q5136) |
Aukelso (Q5161) Bosaya (Q5161) Enoby (Q5167) Xtrenbo (Q5167) Boncresa (Q5171) Jubereq (Q5166) Prolia (J0897) Osvyrti (Q5166) Ponlimsi (Q5173) Xbryk (Q5159) Xgeva (J0897) |
| Infliximab |
Avsola (Q5121) Inflectra (Q5103) |
Infliximab unbranded (J1745) Remicade (J1745) Renflexis (Q5104) |
| Rituximab |
Ruxience (Q5119) Truxima (Q5115) |
Riabni (Q5123) Rituxan (J9312) Rituxan Hycela (J9311) |
| Tocilixumab |
Tocilizumab-aazg IV (Q5135) Avozma IV (Q5156) Tyenne IV (Q5135) |
Actemra IV (J3262) Tyenne SQ (J3590) |
| Trastuzumab IV and SQ |
Kanjinti (Q5117) Traximera (Q5116) |
Trastuzumab-pkrb (Q5113) Herceptin (J9355) Hercessi (Q5146) Herzuma (Q5113) Ogivri (Q5114) Ontruzant (Q5112) Herceptin Hylecta (J9356) |