CommercialPrior AuthMedium impact
New Medications Requiring Approval & Site of Care Management - Effective July 1, 2025
CareFirst BlueCross BlueShield·Provider News
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
Starting July 1, 2025, CareFirst BlueCross BlueShield will require prior authorization approval and site of care management for additional medications for members with commercial insurance. The policy expands existing prior authorization requirements to cover more therapeutic treatments.
Action Required
Before July 1, 2025: Billing team must identify which additional medications will require prior authorization from CareFirst BCBS and update workflow processes accordingly. Monitor CareFirst provider portal for the complete list of affected medications. Notify providers to obtain prior authorization before prescribing newly covered medications to avoid claim denials. Update prior authorization checklists and EMR alerts for CareFirst commercial members.