Back to dashboard
CommercialPrior AuthHigh impact

Medical Preferred Drug Strategy Update: January 1, 2022

CareFirst BlueCross BlueShield·Pharmacy
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Days to comply
—

Summary

Effective January 1, 2022, CareFirst will require step therapy for select medications covered under the medical benefit, meaning preferred medications must be tried first before non-preferred medications can be covered. Providers must obtain prior authorization for non-preferred medications and can request medical necessity exceptions when clinically appropriate.

Action Required

Action needed
Immediately: Billing team must update prior authorization workflows for CareFirst medical benefit medications. Review the 2022 preferred drug lists provided in the policy to identify affected medications. Train staff on new step therapy requirements and update encounter forms to remind providers to check preferred alternatives before prescribing. Implement process to submit prior authorizations through CareFirst Provider Portal for Commercial, Individual and Group Medicare Advantage members, or use Medical Injection Preauthorization Request Form for DualPrime members. Failure to obtain required prior authorization will result in claim denials.

Related policy hubs