Medicare AdvantagePrior AuthHigh impact
Medicare Part B Step Therapy May Updates
Florida Blue·FL · Pulmonology, Rheumatology, Oncology +2 more·Medicare
Effective date
May 15, 2026
We identified it
Jun 16, 2026
Summary
Florida Blue Medicare updated its Part B Step Therapy program effective May 15, 2026, adding new non-preferred drugs and changing preferred status for medications in Asthma, Cancer, and Hemophilia categories. Providers must try preferred alternatives before prescribing non-preferred drugs or face coverage denials.
Action Required
By May 15, 2026: Billing team must update prior authorization requirements for all listed non-preferred drug codes in asthma, autoimmune, cancer, gout, and hemophilia categories. Update EMR systems to prompt providers to try preferred alternatives first. Create step therapy workflow requiring documentation of preferred drug trials before prescribing non-preferred medications. Train clinical staff on new two-step requirements for Exdensur, Qfitlia, and Hympavzi. Claims for non-preferred drugs will be denied without proper step therapy documentation.