Medical Policy Updates

Below is a recap of the Medical Policies that went into effect recently. All policies are reviewed at least once annually. For more detailed information on these changes, please visit here.

Effective August 1, 2026

• Atrial Fibrillation Ablation, Catheter Based
• Breast Implantation and Removal
• Chiropractic Care
• Continuous Passive Motion Devices
• Emergency Department Services
• Evaluation of New Technology, Procedures, Behavioral Health Services, and Programs
• Gas Permeable Scleral Contact Lens
• Home Care Services
• Insulin Infusion Pumps
• Investigational Procedures, Devices, Medical Treatments, and Tests
• Magnetoencephalography and Magnetic Source Imaging
• Minimally Invasive Anti-Reflux Procedures and Peroral Endoscopic Myotomy (POEM)
• Non-Invasive Liver Fibrosis Testing
• Orthotic Devices
• Personal Care and Consumer Directed Services
• Phototherapeutic Keratectomy (PTK) and Refractive Surgery
• Rhinoplasty
• Sinus Surgery and Related Procedures
• Speech Therapy (Outpatient) and Cognitive Rehabilitation

Effective October 1, 2026

• Bone Density Study for Osteoporosis (Dexa)
• Breast Surgery for Gynecomastia
• Bronchial Thermoplasty
• Continuous Glucose Monitoring
• Dermabrasion
• Electrical Stimulation Devices & Therapies
• Endobronchial Valve Devices
• Infertility Services (Basic)
• Laser Treatment of Port Wine Stains, Hemangiomas, and Bening Skin Lesions
• Obstructive Sleep Apnea: Surgical Treatment
• Percutaneous Left Atrial Appendage

Pharmaceutical Policy Updates

Below is a recap of the Pharmacy Policies that went into effect recently. All policies are reviewed at least once annually. For more detailed information on these changes, please review our Provider FastFax Library or visit all policies here.

Formulary Policy Updates

Below is a list of medications recently reviewed by the MVP Pharmacy and Therapeutics Committee. For coverage information regarding these medications, please review the MVP Formularies available at here. For more detailed information regarding pharmacy changes, please review  Provider FastFax Library or visit all policies MVP Health Care Medical Policy.

A list of formulary changes for Plan Year 2026 is available for review: 2026 Commercial and Marketplace Formulary Changes. Changes will take effect on the member’s pharmacy “Plan Year” start date.

Drugs removed from prior authorization for commercial, marketplace and self-funded formularies

New drugs excluded for commercial, marketplace and self-funded formularies

New generics that recently came to market