CommercialPrior AuthMedium impact
Medications Added to Prior Authorization and Site of Care Management Lists – Effective September 1, 2022
CareFirst BlueCross BlueShield·Prior Authorization
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Effective September 1, 2022, CareFirst is adding new medications to their prior authorization and site of care management lists to control specialty drug costs. These medications are covered under the medical benefit and administered in outpatient hospital, home, or office settings.
Action Required
By September 1, 2022: Billing team must access the full CareFirst policy article to identify specific medications added to prior authorization requirements. Update billing system to flag these specialty drugs for prior auth verification before administration. Train clinical staff to obtain prior authorization for affected medications administered in office settings. Claims will be denied without proper prior authorization.