CommercialPrior AuthHigh impact
[California] Prior authorization and step therapy updates for medications billed under the medical benefit
Anthem BCBS·CA·Provider Bulletin
We identified it
Jun 13, 2026
Summary
Anthem California has updated prior authorization and step therapy requirements for medications billed under the medical benefit. This affects drugs administered in clinical settings and billed through medical claims rather than pharmacy benefits.
Action Required
Immediately: Review the full policy bulletin at the source URL to identify specific medications affected by new prior authorization requirements. Update billing workflows to verify prior authorization status before administering medications billed under medical benefit. Train clinical staff on new step therapy protocols that may require trying alternative medications first.