CommercialPrior AuthMedium impact
[New York] New specialty pharmacy medical step therapy requirements
Anthem BCBS·NY · Oncology, Rheumatology, Neurology +3 more·Pharmacy
We identified it
May 30, 2026
Summary
Anthem in New York has implemented new specialty pharmacy medical step therapy requirements, meaning certain specialty medications will now require patients to try and fail on less expensive alternatives before coverage is approved. This affects billing for specialty drug administration and may require additional prior authorization documentation.
Action Required
Immediately: Billing team should contact Anthem New York to obtain the specific list of affected specialty medications and step therapy protocols. Update prior authorization workflows to include step therapy documentation requirements for specialty pharmacy claims. Notify providers that additional documentation of previous medication trials may be required for specialty drug approvals.