All PlansPrior AuthMedium impact
Medications Added to Prior Authorization and Site of Care Management Lists— Effective January 1, 2025
CareFirst BlueCross BlueShield·Oncology, Rheumatology, Neurology +2 more·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Effective January 1, 2025, CareFirst is adding new medications to their prior authorization and site of care management lists to control rising specialty drug costs. These changes affect medications covered under the medical benefit that are administered in outpatient hospital, home, or office settings.
Action Required
By January 1, 2025: Billing team must review the full Provider News article linked in the policy to identify specific medications being added to PA and SOC lists. Update billing system to flag these medications for prior authorization requirements. Train staff on new PA requirements for affected specialty drugs administered in outpatient settings. Claims for these medications without proper prior authorization will be denied.