CommercialPrior AuthHigh impact
Commercial and Other Pharmacy July 1 Updates
Florida Blue·FL · Family Medicine, Internal Medicine, Pediatrics +3 more·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
Florida Blue is implementing comprehensive pharmacy program changes affecting quantity limits, prior authorizations, and coverage exclusions for numerous medications including ADHD medications, diabetes drugs, and specialty medications. The policy adds quantity limits for 32+ medications, requires prior authorization for 26+ new drugs, and excludes coverage for several brand-name medications including Adderall, Vyvanse, and Concerta.
Action Required
Before July 1, 2026: Update pharmacy prior authorization workflows to include 26+ newly added medications requiring pre-approval. Update billing systems with new quantity limits for medications like Adderall, Ozempic, and Wegovy. Train staff on new coverage exclusions including Adderall, Vyvanse, Concerta, and other excluded medications. Verify patient insurance plan type (standard vs Net Results formulary) as exclusions differ between programs. Review current patient prescriptions for affected medications and coordinate with providers for alternative options where coverage is being eliminated.