MedicaidPrior AuthMedium impact
[New York] Prior authorization and step therapy updates for medications billed under the medical benefit
Anthem BCBS·NY · Pharmacy, Hematology, Internal Medicine·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
May 14, 2026
Summary
Effective July 1, 2026, Anthem Blue Cross Blue Shield in New York will require prior authorization for four specialty pharmacy drugs billed under the medical benefit: Fesilty (fibrinogen), Loargys (pegzilarginase), Vykoura (leucovorin calcium), and Yuviwel (navepegritide). Patients currently receiving these medications without prior authorization will require new authorization requests going forward. All medical claims for these drugs must include the National Drug Code (NDC) for processing.
Action Required
Before July 1, 2026: Billing team must identify all patients currently prescribed Fesilty, Loargys, Vykoura, or Yuviwel and establish a process to request prior authorization from Anthem before dates of service. Update billing system to flag these four drugs for prior authorization requirement effective 7/1/2026. Ensure all claims for these medications include the NDC code. Providers should review clinical criteria on Anthem's Clinical Criteria website (reference codes: CC-0149, CC-0301, CC-0104, CC-0300) to understand authorization requirements. Contact Anthem via Availity Chat or provider support line for questions about authorization procedures or clinical criteria.