CommercialPrior AuthMedium impact
Upcoming Pharmacy Program Updates - Effective October 1, 2023
CareFirst BlueCross BlueShield·Pharmacy
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield is adding new medications to their prior authorization and site of care management lists effective October 1, 2023. This quarterly formulary update affects specialty drugs covered under the medical benefit that are administered in outpatient hospital, home, or office settings.
Action Required
By October 1, 2023: Billing team must review the full CareFirst formulary update list to identify specific medications requiring prior authorization. Update billing system to flag affected specialty drugs for prior auth verification before administration. Notify providers to obtain prior authorization for new medications on the list before treating CareFirst patients. Claims may be denied without proper prior authorization.