CommercialPrior AuthHigh impact
New Drug Waste Reduction Guideline
Florida Blue·FL · Oncology, Hematology, Rheumatology +6 more·Pharmacy
Effective date
Jun 1, 2026
We identified it
Jun 16, 2026
Summary
Florida Blue is implementing a new Drug Waste Reduction Guideline effective June 1, 2026, requiring providers to use optimized doses that align with efficient vial combinations for specific injectable medications. The policy affects prior authorization processes and mandates dose optimization (including rounding down up to 10% when clinically appropriate) to reduce medication waste.
Action Required
By June 1, 2026: Providers must order optimized doses as displayed in Prime MPS web portal during prior authorization requests for all listed injectable medications. Billing team must ensure providers cannot bypass optimized dosing requirements and understand that non-compliance will move PA requests to pending status requiring additional clinical review. Update workflows to include exception request processes for valid clinical reasons. Claims for non-optimized doses will require supporting clinical rationale and may be denied without proper authorization.