CommercialCoverageMedium impact
Upcoming CareFirst Formulary Updates Effective January 1, 2024
CareFirst BlueCross BlueShield·Pharmacy
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield is implementing formulary changes effective January 1, 2024, which may include drug additions, tier changes, utilization management updates, and medication removals. These changes will affect prescription coverage for patients with CareFirst pharmacy benefits and could impact prior authorization requirements for medications.
Action Required
By January 1, 2024: Billing team and providers must review the CareFirst formulary update summary document to identify specific medication changes. Update prior authorization workflows and prescription protocols based on the detailed formulary changes. Verify patient medication coverage before prescribing to avoid coverage denials.