CommercialCoverageMedium impact
Upcoming CareFirst Formulary Updates Effective January 1, 2023
CareFirst BlueCross BlueShield·Pharmacy
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield is implementing formulary updates effective January 1, 2023, which may include drug additions, tier changes, utilization management changes, and medication removals. These changes affect patients with CareFirst prescription benefits and could impact prescribing patterns and prior authorization requirements for medications.
Action Required
By January 1, 2023: Billing and clinical staff must review the CareFirst formulary updates summary document to identify specific changes affecting commonly prescribed medications. Update EMR alerts and provider reference materials with new formulary restrictions, tier changes, and prior authorization requirements. Monitor for increased prior authorization requests and claim denials related to formulary changes.