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Commercial and Other Pharmacy Updates of April 1
Effective date
Apr 1, 2026
Identified
Jun 16, 2026
Summary
Florida Blue commercial and other pharmacy program updates became effective April 1, 2026. They add drugs to the Responsible Quantity Program with dispensing limits, add drugs to the Prior Authorization Program, add topical corticosteroids to the Step Therapy Program, and remove listed brand and generic drugs from pharmacy coverage for members in plans that allow coverage exclusions. Net Results formulary members have separate changes, including new exclusions, one drug added back to coverage, prior authorization additions and new quantity limits.
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What to do
Action · 8 steps
01Already effective April 1, 2026: For members whose plans are part of the Prior Authorization Program, prior authorization requirements changed for the listed drugs, and criteria summaries are available with the authorization forms.
02For Net Results Formulary members, prior authorization requirements changed for the drugs on the Net Results Prior Authorization Program list, and authorization request forms are available at MyPrime.com.
03For members in the Responsible Quantity Program, the listed dispensing limits apply, and they also apply to generic drugs.
04For members in the Net Results Quantity Limit Program, the listed quantity limits apply per 30-day supply unless otherwise indicated.
05Verify patients' eligibility and pharmacy benefits on Availity Essentials at Essentials.Availity.com.
06Check the current preferred drug lists at FloridaBlue.com/providers under Tools & Resources, then Medical & Pharmacy Policies, Guidelines, then Medication Guides.
07Direct questions to the Provider Contact Center at 1-800-727-2227.
08Check current applicability of these changes before acting.
Original notice
Commercial and Other Pharmacy Updates of April 1
files.guidewell.com · Always check the source before changing claims.
Related changes
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