CommercialPrior AuthMedium impact
New Medications Requiring Approval and Site of Care Management
CareFirst BlueCross BlueShield·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Starting April 1, 2026, CareFirst will require prior authorization approval and site of care management for additional medications for members with commercial insurance. The policy affects medication coverage and requires providers to obtain approval before prescribing certain treatments.
Action Required
Before April 1, 2026: Billing team must identify which additional medications will require prior authorization from CareFirst and update workflows to obtain approval before prescribing. Contact CareFirst or review the full policy update to get the specific list of affected medications. Implement prior auth checks in EMR system for these medications. Claims for covered medications without prior authorization will likely be denied.