September Provider Notification
Date: 09/22/26
Ambetter from Arkansas Health & Wellness is amending or implementing new policies. Please see the table below for a list of these policies and their effective dates.
| Policy | Policy Name | Revision | Effective Date |
|---|---|---|---|
| CP.PCH.32 | Dapsone (Aczone Gel) | Per August SDC, removed Clindagel from Appendix B. | 1/1/2027 |
| CP.PCH.42 | Deutetrabenazine (Austedo, Austedo XR) | Retired, replaced by CP.CPA.370 and CP.PHAR.341 | 1/1/2027 |
| CP.PCH.64 | Continuous Glucose Monitors | Policy created (adapted from CP.CPA.355) per August SDC: added HIM/ICHRA line of business. | 1/1/2027 |
| CP.PHAR.103 | Immune Globulins | Per August SDC, added HIM and ICHRA line of business; updated Appendix G with revised language for Tennessee; for Nebraska HIM line of business, added allowance of bypassing the exclusion of PANDAS in section III per state regulations. | 1/1/2027 |
| CP.PHAR.341 | Deutetrabenazine (Austedo, Austedo XR) | Per August SDC, added HIM/ICHRA lines of business. | 1/1/2027 |
| CP.PMN.143 | Isotretinoin (Claravis Absorica Absorica LD Myorisan Zenatane Amnesteem) | Per August SDC, removed Clindagel from Appendix B. | 1/1/2027 |
| CP.PMN.295 | Semaglutide (Wegovy) | Per August SDC: updated redirection to preferred GLP-1 receptor agonist therapies from “failure of three of the following” to “failure of all of the following” for members with concurrent T2DM. | 1/1/2027 |
| CP.PMN.298 | Tirzepatide (Zepbound) | Per August SDC: updated redirection to preferred GLP-1 receptor agonist therapies from “failure of three of the following” to “failure of all of the following” for members with concurrent T2DM. | 1/1/2027 |
| CP.PMN.58 | Propranolol (Hemangeol) | Per August SDC, added HIM line of business. | 1/1/2027 |
| HIM.PA.09 | Insulin glargine (Basaglar, Lantus, Rezvoglar, Toujeo) | Per August SDC: for Focused plans, added statement that Lantus, Toujeo, and unbranded Toujeo do not require prior authorization and added redirection to them as preferred products. | 1/1/2027 |
| HIM.PA.153 | Inhaled asthma and COPD agents | Per August SDC: for Focused plans, added statement that Asmanex HFA, Asmanex Twisthaler, Tudorza Pressair, and Bevespi Aerosphere do not require prior authorization and added redirection to them as preferred products. | 1/1/2027 |
| HIM.PA.161 | Human Growth Hormone (Somapacitan, Somatrogon, Somatropin, Lonapegsomatropin-tcgd) | Per August SDC, removed Humatrope as a preferred drug. | 1/1/2027 |
| HIM.PA.168 | Corticotropin (H.P. Acthar, Purified Cortrophin Gel) | Per August SDC, removed ICHRA line of business, for Focused plans, added redirection of Acthar to Purified Cortrophin Gel. | 1/1/2027 |
| HIM.PA.169 | Berotralstat (Orladeyo) | Per August SDC, added redirection to Haegarda for Focused plans only. | 1/1/2027 |
| HIM.PA.171 | Insulin detemir (Levemir) 08.18.26_SDC | Retired per August SDC. | 1/1/2027 |
| HIM.PA.172 | Lanadelumab-fylo (Takhzyro) | Per August SDC, added redirection to Haegarda for Focused plans only. | 1/1/2027 |
| HIM.PA.173 | Palbociclib (Ibrance) | Per August SDC: for breast cancer, removed redirection to Kisqali. | 1/1/2027 |
| HIM.PA.178 | Immune Globulins_08.18.26 SDC | Retired per August SDC. | 1/1/2027 |
| HIM.PA.180 | Insulin Icodec-abae (Awiqli) | Per August SDC: for Focused plans, added redirection to Lantus, Toujeo, and unbranded Toujeo. | 1/1/2027 |
| HIM.PA.53 | GLP-1 receptor agonists | Per August SDC: updated redirection to preferred GLP-1 receptor agonist therapies from “failure of three of the following” to “failure of all of the following.” | 1/1/2027 |
| HIM.PA.58 | DPP-4 inhibitors | Per August SDC: added brand Januvia, Janumet, and Janumet XR to policy with redirection to generic; added ICHRA line of business. | 1/1/2027 |
| HIM.PA.71 | Topical Acne Treatment | Per August SDC, removed Clindagel from Appendix B. | 1/1/2027 |
| HIM.PA.87 | Testosterone (Androderm) | Retired per August SDC. | 1/1/2027 |
| HIM.PA.91 | SGLT2 inhibitors | Per August SDC: added brand Farxiga and Xigduo XR to criteria with redirection to generic; added ICHRA line of business. | 1/1/2027 |
| HIM.PA.SP60 | Biologic and Non-biologic DMARDs | Per August SDC: for CD, PsO, PsA, and UC, removed redirection to Stelara as agent is not preferred; removed step through criteria for initiating therapy for Stelara; added redirection to Imuldosa as agent is preferred). | 1/1/2027 |
Ambetter’s clinical, payment, and pharmacy policies can be found at AmbetterHealth.com/en/ar/provider-resources/clinical-payment-policies.html. New or amended policies are available here as well. To easily search for a policy:
Expand the accordions at the bottom of the page to view all available policies.
Use the Ctrl+F (or Command+F on Mac) function on your keyboard to search by keyword, policy number, or effective date.
New or amended policies are also available on our Provider News page. To view recent updates, visit the Provider News page and select the policy update you are interested in to view the details.
If you have questions, please call 1-877-617-0390 (TTY: 1-877-617-0392) or email Providers@ARHealthWellness.com.