January 2022

In addition to the summary of monthly changes below, please also review our monthly Bulletin for recent and upcoming changes to our medical and reimbursement policies, Clinical Position Statements and associated changes to pre-authorization requirements. The Medical Policy Manual includes a list of recent updates and archived policies. Monthly change summaries are added to our website within 10 business days of our newsletter publication.

Review other monthly changes for 2022.

Facility claims (ANSI 837I claims) received on or after July 1, 2021, that span from one calendar year to the next (e.g., December 28, 2020, to January 3, 2021), will be denied automatically if they are submitted on the same claim.

Read the April 2021 issue of our newsletter for details.

Effective January 1, the following codes were added to our pre-authorization lists.

Commercial

• Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer (Genetic Testing #42)
  • CPT® 81523
• Bariatric Surgery (Surgery #58)
  • CPT 43845
• Chromosomal Microarray Analysis (CMA) or Copy Number Analysis for the Genetic Evaluation of Patients with Developmental Delay, Intellectual Disability, Autism Spectrum Disorder, or Congenital Anomalies (Genetic Testing #58)
  • CPT 81349
• Digital Health Products (Medicine #175)
  • CPT 0702T, 0703T
• Digital Health Products for Attention Deficit Hyperactivity Disorder (Medicine #175.01)
  • CPT 0702T, 0703T
• Digital Health Products for Substance Use Disorders (Medicine #175.02)
  • CPT 0702T, 0703T
• Evaluating the Utility of Genetic Panels (Genetic Testing #64)
  • CPT 81349
• Gait Analysis (Medicine #107)
  • CPT 0693T
• Gender Affirming Interventions for Gender Dysphoria (Medicine #153)
  • CPT 54400, 54401, 54405; HCPCS C2622
• Genetic and Molecular Diagnostic Testing (Genetic Testing #20)
  • CPT 81349
• Genetic Testing for the Evaluation of Products of Conception and Pregnancy Loss (Genetic Testing #79)
  • CPT 81349
• Genetic Testing; Reproductive Carrier Screening for Genetic Diseases (Genetic Testing #81)
  • CPT 81161
• Hypoglossal Nerve Stimulation (Surgery #215)
  • CPT 64582, 64583
• Invasive Prenatal Fetal Diagnostic Testing for Chromosomal Abnormalities (Genetic Testing #78)
  • CPT 81349
• Laser Interstitial Thermal Therapy (Medicine #177)
  • CPT 61736, 61737
• Preimplantation Genetic Testing of Embryos (Genetic Testing #18)
  • CPT 81349
• Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy of Intracranial, Skull Base, and Orbital Sites (Surgery #213)
  • CPT 77301, 77338
• Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy for Tumors Outside of Intracranial, Skull Base, or Orbital Sites (Surgery #214)
  • CPT 77301, 77338

• Transcutaneous Bone-Conduction and Bone-Anchored Hearing Aids (Surgery #121)

  • CPT 69716, 69719, 69726, 69727

Uniform Medical Plan (UMP)

• ABA Applied Behavior Analysis for the Treatment of Autism Spectrum Disorders (Behavioral Health #18)
  • CPT 0362T, 0373T, 97151-97158
• Applied Behavior Analysis (ABA) Therapy
  • Effective January 1, pre-authorization only required for UMP members age 18 and older
• Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer (Genetic Testing #42)
  • CPT 81523
• Bariatric Surgery (Surgery #58)
  • CPT 43845
• Chromosomal Microarray Analysis (CMA) or Copy Number Analysis for the Genetic Evaluation of Patients with Developmental Delay, Intellectual Disability, Autism Spectrum Disorder, or Congenital Anomalies (Genetic Testing #58)
  • CPT 81349
• Digital Health Products (Medicine #175)
  • CPT 0702T, 0703T
• Digital Health Products for Attention Deficit Hyperactivity Disorder (Medicine #175.01)
  • CPT 0702T, 0703T
• Digital Health Products for Substance Use Disorders (Medicine #175.02)
  • CPT 0702T, 0703T
• Evaluating the Utility of Genetic Panels (Genetic Testing #64)
  • CPT 81349
• Gait Analysis (Medicine #107)
  • CPT 0693T
• Gender Affirming Interventions for Gender Dysphoria (Medicine #153)
  • CPT 54400, 54401, 54405; HCPCS C2622
• Genetic and Molecular Diagnostic Testing (Genetic Testing #20)
  • CPT 81349
• Genetic Testing for the Evaluation of Products of Conception and Pregnancy Loss (Genetic Testing #79)
  • CPT 81349
• Genetic Testing; Reproductive Carrier Screening for Genetic Diseases (Genetic Testing #81)
  • CPT 81161
• Genomic Microarray Testing
  • CPT 81349
• Hypoglossal Nerve Stimulation (Surgery #215)
  • CPT 64582, 64583
• Invasive Prenatal Fetal Diagnostic Testing for Chromosomal Abnormalities (Genetic Testing #78)
  • CPT 81349
• Laser Interstitial Thermal Therapy (Medicine #177)
  • CPT 61736, 61737
• Preimplantation Genetic Testing of Embryos (Genetic Testing #18)
  • CPT 81349
• Spine, pain and joint services
  • Regence will begin reviewing pre-authorization requests for spine, pain and joint services rendered to UMP members on or after January 1, 2022. This change applies to School Employees Benefits Board (SEBB) and Public Employees Benefits Board (PEBB) members. Note: eviCore healthcare (eviCore) currently reviews these requests and will continue to do so for services performed through December 31, 2021.
• Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy of Intracranial, Skull Base, and Orbital Sites (Surgery #213)
  • CPT 77301, 77338
• Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy for Tumors Outside of Intracranial, Skull Base, or Orbital Sites (Surgery #214)
  • CPT 77301, 77338

• Transcutaneous Bone-Conduction and Bone-Anchored Hearing Aids (Surgery #121)

  • CPT 69716, 69719, 69726, 69727

Medicare Advantage

• Autologous Blood-Derived Growth Factors as a Treatment for Wound Healing and Other Miscellaneous Conditions (Medicare Advantage – Medicine #77)
  • HCPCS G0465
• Bioengineered Skin and Soft Tissue Substitutes and Amniotic Products (Medicare Advantage – Medicine #170)
  • HCPCS A2001—A2010, Q4199
• Gait Analysis (Medicare Advantage – Medicine #107)
  • CPT 0693T
• Gender Affirming Interventions for Gender Dysphoria (Medicare Advantage – Medicine #153)
  • CPT 54400, 54401, 54405; HCPCS C2622
• Genetic and Molecular Diagnostics – Next Generation Sequencing and Genetic Panel Testing (Medicare Advantage – Genetic Testing #64)
  • CPT 81349, 81523
• Genetic and Molecular Diagnostics – Single Gene or Variant Testing (Medicare Advantage – Genetic Testing #20)
  • CPT 81349
• Hypoglossal Nerve Stimulation (Medicare Advantage – Surgery #215)
  • CPT 64582, 64583

• Laser Interstitial Thermal Therapy (Medicare Advantage – Medicine #177)

  • CPT 61736, 61737

Federal Employee Program

• Radiology

  • Prior approval from AIM Specialty Health required for the following CPT codes: 70336, 70450, 70460, 70470, 70480–70482, 70486–70488,
    70490–70492, 70496, 70498, 70540, 70542–70549, 70551–70555, 71250, 71260, 71270, 71271, 71275, 71550–71552, 71555, 72125–72133, 72141, 72142, 72146–72149, 72156–72159, 72191–72198, 73200–73202, 73206, 73218–73220, 73225, 73718–73723, 73725, 73221–73223, 73700–73702, 73706, 74150, 74160, 74170, 74174–74178, 74181–74183, 74185, 74712, 75557, 75559, 75561, 75563, 75572–75574, 75635, 76391, 77046–77049, 77078, 77084, 78429–78433, 78451–78454, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78608, 78609, 78811–78816, 93303, 93304, 93306–93308, 93312–93317, 93350, 93351, 0501T–0504T

Please review our pre-authorization lists for all updates and pre-authorize services accordingly. You can submit standard medical pre-authorizations through Availity Essentials. Learn more about electric authorizations.

The following sections of our Administrative Manual were updated effective January 1, 2022:

• Appeals for Members

• Facility Guidelines, Hospice VBID Model, Medicare Advantage (Regence BCBSO and Regence BCBSU)

Effective January 1, 2022, most radiology services for Blue Cross and Blue Shield Federal Employee Program® (BCBS FEP®) members in Oregon, Utah and Clark County, Washington, will require prior approval through AIM Specialty Health (AIM). This change applies to our Standard Option, Basic Option and FEP Blue Focus plans.
Providers can begin requesting prior approval on December 6, 2021, for services that will be rendered on or after January 1, 2022.

When to contact Regence for prior approval

All FEP plans currently require prior approval for the following codes: CPT 77301, 77338, 77385 and 77386; HCPCS G6015 and G6016. You will continue to contact Regence directly for prior approval of these codes for all FEP plans.

FEP Blue Focus only: Additional radiology codes will continue to require prior approval. Contact Regence directly for prior approval on these codes for FEP Blue Focus members only:

• CPT 70558, 70559, 74261-74263, 74713, 75565, 75571, 76376, 76377, 76380, 76390, 76497, 76498, 77011-77014, 77021, 77022, 78071, 78072, 78434, 78803, 78830-78832, 78835, 0042T, 0332T, 0398T, 0558T, 0609T-0612T, 0633T-0638T, 0648T and 0649T

• HCPCS C8903, C8905, C8906, C8908, G0288 and S8092

Our FEP pre-authorization lists will be updated December 1, 2021.

As of January 1, 2022, physical therapy (PT), occupational therapy (OT) and speech therapy (ST) services for Uniform Medical Plan (UMP) members no longer require pre-authorization.

This change includes both School Employees Benefits Board (SEBB) and Public Employees Benefits Board (PEBB) members.

Regence will begin reviewing pre-authorization requests for spine, pain and joint services rendered to Uniform Medical Plan (UMP) members on or after January 1, 2022. This change applies to School Employees Benefits Board (SEBB) and Public Employees Benefits Board (PEBB) members. eviCore healthcare (eviCore) will continue to review requests for these services performed through 2021.

Beginning November 22, 2021, providers can submit pre-authorization requests through the electronic authorization tool on Availity for spine, pain and joint services that are scheduled to be performed on or after January 1, 2022.

Spinal injections for UMP members require a provider attestation beginning January 1, 2022. Submit the attestation through Availity Essentials to expedite claims processing. If you don’t use Availity to submit your attestation, you will need to supply the completed Spinal Injection Additional Information Form when we request it.

Spinal injections may be subject to HTCC.

We publish updates to medical policies in our monthly publication, The Bulletin. You can read issues of The Bulletin or subscribe to receive an email notification when issues are published.

We provided 90 day notice in the October 2021 issue of The Bulletin about the following medical policy, which is effective January 1, 2022:

• Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer (Genetic Testing #42)

• Transcranial Magnetic Stimulation as a Treatment of Depression and Other Disorders (Medicine #148)

We publish updates to reimbursement policies in our monthly publication, The Bulletin. You can read issues of The Bulletin or subscribe to receive an email notification when issues are published.

We provided 90 day notice in the October 2021 issue of The Bulletin about the following reimbursement policies, which are effective January 1, 2022:

• Care Management Services (Administrative #122)
• Drugs and Radiopharmaceuticals Reimbursed Under Medical Coverage (Medicine #104 and Medicare Advantage—Medicine #104)
• Hospice (Medicare Advantage—Administrative #140) (applies to Regence BlueCross BlueShield of Oregon and Regence BlueCross BlueShield of Utah only)
• Hospice Transitional Concurrent Care (Medicare Advantage—Administrative #139) (applies to Regence BlueCross BlueShield of Oregon and Regence BlueCross BlueShield of Utah only)
• Reimbursement Methodology for Non-Participating Providers (Administrative #135)

• Reimbursement of Neonatal Intensive Care Unit—Level of Care (Facility #112)

The following edits are effective January 1, 2022:

• A new rule will limit CPT 97140 to four units per date of service for commercial, self-funded and Medicare Advantage claims.

• A revised rule that previously only applied to Washington-based massage providers will now deny excess units of CPT 97112 when billed with CPT 97140 or 97124 for massage providers in Idaho, Oregon and Utah.

For dates of service on or after February 1, 2022, medically unlikely edits (MUEs) will apply to all Medicare Advantage claims when the CMS MUE tables indicate a value of 0.

The following codes will be added to the specialty medication pre-authorization lists for CHG Healthcare Services (group #70000004), IEC Group (group #70000000) and Alsco Inc. (group #70000002) members, effective January 1, 2022: HCPCS J0480, J2406, J7402, J7520 and S0189.

Effective January 1, 2022, we are adding Livongo for Hypertension to our portfolio of buy-up options offered in partnership with Livongo for our administrative services only (ASO) groups. Currently, we offer Livongo’s Diabetes Prevention, Diabetes Management and Weight Management programs.

The Livongo for Hypertension program provides the tools, insights, and expert support that help make managing blood pressure simple. Participants will receive:

• A connected blood pressure monitor
• Real-time insights after each reading
• Food and activity tracking
• One-on-one support from expert coaches

• Access to a mobile app for easy tracking and personalized tips

Strive Health is our new kidney health management partner for fully insured commercial and Medicare Advantage members living in Idaho, Utah and Washington. We partnered with Strive in 2021 to serve members in Oregon and Clark County, Washington. Strive began contacting providers with eligible members in Idaho, Utah and Washington in January 2022.

Eligible members can receive assistance with finding cost-effective and convenient dialysis and kidney transplant options. Support is customized to fit the patient’s needs and preferences.

Effective January 1, 2022, Northwest Fire Fighters Benefits Trust (NWFFT) (group #70000014), a self-funded employer group headquartered in Washington, will transition from Regence to MagnaCare.

MagnaCare, a third-party administrator, will provide claims administration, medical management and member services.

Eligible claims will be reimbursed based on your Regence agreement. Regence will continue to receive claims from providers, issue provider payments and provide participating provider servicing.

Learn more about MagnaCare and NWFFT.

In our ongoing efforts to reward high-quality care provided to Regence Medicare Advantage members, we review the quality ratings of participating home health agencies on an annual basis. We use the Quality of Patient Care Star Ratings, which reflect the prior calendar year’s data and are available in July of the current year to determine the quality rating for each home health agency. Effective January 1, 2022, Regence will use the ratings reported in July 2021.

Home health agencies can view their CMS Quality of Patient Care Star Ratings. The criteria for determining the quality rating for home health agencies is outlined in the Facility Guidelines section of our Administrative Manual.

Two important mandates, effective January 1, 2022, will bring changes to how directory information is validated and reimbursement rates are disclosed.

Transparency in Coverage (TIC) Final Rule requires payers to provide members with a self-service cost-sharing estimator tool that provides personalized estimates based on the member’s coverage. It also requires payers to publicly disclose, in machine-readable files:

• In-network negotiated rates for all covered items and services
• Allowed amounts for out-of-network providers and pharmacies

• Prescription drug pricing for in-network pharmacies

Consolidated Appropriations Act (CAA), 2021, requires payers to:

• Provide members with an Explanation of Benefits (EOB) three days in advance of scheduled services from a participating provider or health care facility
• Maintain a price comparison tool that allows members and participating providers to compare cost-sharing for items and services from any participating provider
• Establish a verification process to confirm directory information at least every 90 days and respond to member network questions within one business day

• Hold members responsible only for in-network cost-sharing if they receive incorrect directory information

Under TIC, providers’ billing identification will be required to be disclosed. If you are using your Social Security number (SSN) as your provider number for billing purposes, this information will be made publicly available. We strongly encourage you to apply for a tax ID or Employer Identification Number (EIN) and notify us promptly of the change.

• Request a tax ID or EIN on the Internal Revenue Service (IRS) website.

• Notify us of the change by submitting a Provider Information Update Form.

Learn more about TIC on the Centers for Medicare & Medicaid Services (CMS) website.

Under CAA, you will be required to provide attestation that you have validated your directory information at least every 90 days. Providers who do not validate their directory information must be suppressed from our provider directory under the CAA Act. We are actively researching ways to make the process of validating directory information as easy as possible. Please continue to:

• Review information about your practice at least every 90 days.

• Notify us promptly of changes to your directory information by submitting a Provider Information Update Form.

Learn more about CAA on the Congress website.

Look for additional information about this legislation in our October and December 2021 newsletter issues.

The Consolidated Appropriations Act (CAA), 2021, effective January 1, 2022, requires health plans to establish a process to verify and update provider directory information no less frequently than every 90 days. Providers are required to submit directory information upon request by the health plan. Having accurate provider directory information is also a requirement for compliance with CMS, the ACA and your agreement as a network provider for Regence patients.

We are defining our policy to require frequent provider verifications in compliance with the CAA and actively researching ways to make the process of validating directory information as easy as possible, including launching a tool on Availity Essentials, availity.com. Please continue to:

• Review information about your practice at least every 30 days.

• Notify us promptly of changes to your directory information by submitting a Provider Information Update Form

Read frequently asked questions about CAA and the Affordable Care Act.

The Transparency in Coverage (TIC) Final Rule, effective January 1, 2022, requires us to provide members with a self-service cost-sharing estimator tool that provides personalized estimates based on the member’s coverage. It also requires us to publicly disclose, in machine-readable files:

• In-network negotiated rates for all covered items and services
• Allowed amounts for out-of-network providers and pharmacies

• Prescription drug pricing for in-network pharmacies

As a requirement of the TIC rule, providers’ billing identification will be disclosed. If you are using your Social Security number (SSN) for billing purposes, this information will be made publicly available. We strongly encourage you to apply for a tax ID or Employer Identification Number (EIN) and notify us promptly of the change

• Request a tax ID or EIN on the on the IRS website irs-gov-taxid.com.

• Notify us of the change by submitting a Provider Information Update Form

As a reminder, while Regence must disclose negotiated reimbursement rates under this rule, our reimbursement schedules are still confidential and proprietary. Contracted providers should continue to adhere to the protections required of this information in accordance with the terms of our provider agreements.

Learn more about TIC on CMS’ website.

Listed below is a summary of medication policy additions and changes. Links to all medication policies, medication lists and pre-authorization information for our members, including real-time deletions from our pre-authorization lists, are available on our website.

New medication policies effective January 1, 2022

• Lumakras, sotorasib, dru683
• Medications for Multiple Myeloma, other cancers, and other hematologic disorders, dru672
• Truseltiq, infigratinib, dru676

• vosoritide, dru687

Revised medication policies effective January 1, 2022

• Intravitreal Vascular Endothelial Growth Factor (VEGF) Inhibitors, dru621
• Medications for Multiple Myeloma, other cancers, and other hematologic disorders, dru672
• Non-Preferred Products with Therapeutically Equivalent Interchangeable Biosimilars/Reference Products, dru620
• Medicare Part B: Chimeric Antigen Receptor (CAR) T-cell products will require pre-authorization beginning January 1, 2022. Coverage criteria in National Coverage Determination (NCD) 110.24 will apply.
• Anabolic Bone Medications, dru612
• Ayvakit, avapritinib, dru624
• Bosulif, bosutinib, dru285
• CGRP Monoclonal Antibodies, dru540
• Complement Inhibitors, dru385
• Drugs for chronic inflammatory diseases, dru444
• Gonadotropin-releasing hormone combination products, dru655
• Growth Hormone, dru015
• Iclusig, ponatinib, dru292
• Lenvima, lenvatinib, dru398
• Lorbrena, lorlatinib, dru582
• Monoclonal antibodies for asthma and other immune conditions, dru538
• Non-Preferred Combination SGLT2/ DPP4-Inhibitor-Containing Medications, dru689
• Non-Preferred Glatiramer Products, dru570
• Non-Preferred Injectable Insulins, dru372
• Non-preferred multiple sclerosis treatments, dru511
• Non-Preferred SGLT2-Inhibitor-Containing Medications, dru543
• Non-preferred testosterone replacement therapy products, dru548
• Ocrevus, ocrelizumab, dru479
• Products with Therapeutically Equivalent Biosimilars/Reference Products, dru620 and dru905
• Prolia, denosumab, dru223
• Retevmo, selpercatinib, dru643
• Site of Care Review, dru408
• Tagrisso, osimertinib, dru441
• Topical antifungal nail solutions, dru384
• Xalkori, crizotinib, dru265

• Zeposia, ozanimod, dru674

Read the October 2021 and December 2021 issues of our newsletter for details.

Effective January 1, 2022, Inflectra will be our preferred infliximab product. Members, including Uniform Medical Plan (UMP) members, who are currently on an infliximab product other than Inflectra, such as Remicade, Renflexis, Avsola or Ixifi, will need to transition to Inflectra for coverage on or after January 1, 2022.

All existing pre-authorizations for non-preferred infliximab products will end on December 31, 2021.

We started notifying members of this change in September 2021.

Modified authorizations

To make the transition easier, we will automatically transfer all existing pre-authorizations for any infliximab product to Inflectra, so your patients can continue infliximab treatment without interruption. For patients currently on one of the affected products, you should have received a modified authorization letter for Inflectra. You do not need to take any action for your patients to switch to Inflectra on January 1, 2022.

If you wish to start your patient on Inflectra before January 1, 2022, please submit a new pre-authorization request through covermymeds.com.

If Inflectra is not a treatment option for a patient, you can submit a new pre-authorization request for one of the non-preferred medications (Remicade, Renflexis, Avsola or Ixifi) through covermymeds.com for dates of service on or after January 1, 2022. Members who are currently on an infliximab product other than Inflectra will need to transition to Inflectra on or after January 1, 2022. We will begin notifying members of this change in September 2021.

To make the transition easier, we will automatically convert all existing pre-authorizations for any infliximab product to Inflectra. We will send you patient-specific notifications of these changes in August 2021. You do not need to submit new pre-authorization requests for patients to switch to Inflectra. If Inflectra is not a treatment option for a patient, you can submit a new pre-authorization request for one of the non-preferred medications through covermymeds.com.

Infliximab product coverage effective January 1, 2022:

Preferred medication

• Inflectra - HCPCS Q5103

Non-preferred medications

• Remicade - HCPCS J1745
• Renflexis - HCPCS J5104
• Avsola - HCPCS Q5121

• Ixifi - HCPCS Q5109

Notes:

• Infusion therapy site of care approvals will not be affected by this change. Members can continue receiving their infusions at the same location they do currently.

• All infliximab products currently require pre-authorization and will continue to on or after January 1, 2022.

Please remember to review your 2022 CPT, HCPCS and CDT coding publications for codes that have been added, deleted or changed and to use only valid codes.

You can purchase the:

• CDT manual by calling the American Dental Association at 1 (800) 947-4746 or online at ebusiness.ada.org
• CPT and HCPCS manuals through your preferred vendor or online through the American Medical Association (AMA) at commerce.ama-assn.org/store

• Reimbursement information is available on Availity Essentials, availity.com.

This notice serves as an Amendment to your Participating Agreement. You have the right to terminate your Agreement in accordance with the amendment provisions of the Participating Agreement.

The Consolidated Appropriations Act (CAA) contains several mandates supporting improved cost transparency and protections for members of commercial health plans. One mandate requires in-network (INN) and out-of-network (OON) cost-shares—deductible and out-of-pocket maximum—to be printed on member ID cards. This will help prevent confusion about out-of-pocket expenses. We have redesigned our member ID cards to accommodate this mandate and will issue new cards to all members across all lines of business upon renewal beginning January 1, 2022.

Impact on members
To make room for the mandated INN and OON cost-share information on the front of our member ID cards, we’re removing dependents’ names and their coverage types. This change will require us to issue member-level cards; each covered member, regardless of age, will receive their own member ID card. There will be no charge for groups and members for their new cards.

These changes will also enable us to list the PCP on the front of the card for each member who has a designated PCP.

No changes will be made to the back of the member ID cards.

Impact on providers
Please check the member’s ID card and verify eligibility on Availity Essentials. Because the cards will be issued at the member level, you’ll need to verify the name on the card matches the name of the patient.

Sample cards will be added to the Identifying Members page on our provider website by December 15, 2021.

Effective January 1, 2022, we are adding step therapy requirements for the following medications covered under Medicare Part B. The non-preferred medications listed below require pre-authorization and will only be covered if the cost-effective preferred medications have been ineffective, were not tolerated or are not a treatment option.

This change will not affect members currently receiving one of the non-preferred medications. The exception to this is intra-articular hyaluronic acids unless they are mid-course.