CommercialPrior AuthHigh impact
Medications Added to Prior Authorization and Site of Care Management Lists - Effective January 1, 2023
CareFirst BlueCross BlueShield·Oncology, Rheumatology, Neurology +4 more·Prior Authorization
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Effective January 1, 2023, CareFirst added multiple specialty medications to their prior authorization and site of care management lists to control rising specialty drug costs. These medications are covered under the medical benefit and administered in outpatient hospital, home, or office settings.
Action Required
By January 1, 2023: Billing team must update prior authorization workflows for specialty medications administered in outpatient, home, or office settings. Review the full CareFirst article at the source URL to identify specific medications now requiring prior authorization. Update billing system to flag these medications for prior auth verification before administration. Train clinical staff on new site of care management requirements. Claims will be denied without proper prior authorization.