CommercialPrior AuthMedium impact
Upcoming CareFirst Formulary Updates
CareFirst BlueCross BlueShield·Prior Authorization
Effective date
Apr 1, 2021
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield is updating its commercial and exchange formularies effective April 1 for Formularies 1-4 and May 1 for Exchange Formulary. Changes include utilization management updates, drug tier modifications, and medication removals that may require new prior authorizations for prescription benefits.
Action Required
By April 1, 2021: Review CareFirst formulary changes summary at the provided link to identify which medications now require prior authorization or have been removed. Update prescription ordering protocols and inform providers of new utilization management requirements. By May 1, 2021: Apply same updates for Exchange Formulary patients. Monitor for claim denials related to formulary changes.