CommercialPrior AuthMedium impact
[New York] Anthem expands specialty pharmacy precertification list
Anthem BCBS·NY · Oncology, Rheumatology, Neurology +3 more·Pharmacy
We identified it
Jun 13, 2026
Summary
Anthem has expanded their specialty pharmacy precertification list, requiring additional prior authorizations for certain specialty medications. This affects billing for specialty drugs and may result in claim denials if precertification is not obtained before dispensing or administration.
Action Required
Immediately: Review the updated Anthem specialty pharmacy precertification list at the provided URL. Update billing system alerts to flag specialty medications requiring prior authorization. Train staff to verify precertification status before administering specialty drugs. Implement workflow to obtain precertification for newly added medications to avoid claim denials.