Blue Shield of California is making an important policy change for cancer care: prior authorization will no longer be required for certain biomarker testing services in specific advanced cancer cases. This update aims to improve access to critical diagnostics and speed up treatment decisions.
What’s Changing
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For enrollees with advanced metastatic stage 3 or 4 cancer, certain biomarker tests—those for cancer progression or recurrence—will now be covered without needing prior authorization.
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The change is in compliance with SB 535, which mandates this removal of prior authorization under certain conditions.
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This applies to Blue Shield’s delegated provider organizations that are financially responsible for those services.
Why It Matters for Members & Employers
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Faster diagnostics: Patients won’t face delays in critical testing, which helps oncologists make informed treatment decisions more quickly.
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Reduced administrative burden: No more waiting on prior authorization approvals for these biomarker tests in the specified cancer stages.
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Potential cost savings: Patients may avoid out-of-pocket delays or denials due to PA requirements.
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Employer benefit design: Employers offering Blue Shield plans can highlight this as an improved benefit, improving plan competitiveness and member satisfaction.
What Brokers Should Do
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Review plan documents and ensure member materials clearly reflect this policy change
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Update benefit summaries and ID card inserts if necessary, to avoid confusion among members and providers
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Educate providers in your network so they know when they can order these biomarker tests without PA approval
How BetterFit Benefits Can Help
At BetterFit Benefits, our goal is to keep you ahead of policy updates that impact care. We can help you by:
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Auditing your Blue Shield plan offerings to confirm which cancer and provider settings qualify under the new PA-removal rules
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Informing employees and members about this change so they can access testing without unnecessary hurdles
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Assisting with renewal discussions, comparing Blue Shield’s new policy to other carriers to ensure you’re getting the best offer