CommercialPrior AuthHigh impact
Commercial and Other Pharmacy Updates of April 1
Florida Blue·FL·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 16, 2026
Summary
Florida Blue is implementing major pharmacy changes effective April 1, 2026, including adding 40+ medications to quantity limits, adding 33+ drugs requiring prior authorization, and excluding 40+ brand-name drugs from coverage. These changes affect both regular commercial plans and Net Results formulary plans.
Action Required
By April 1, 2026: Clinical staff must obtain prior authorization for 33+ newly added medications including Wegovy, Cimzia, gabapentin once-daily formulations, and other specialty drugs for FDA-approved indications only. Update EMR alerts for quantity-limited medications (40+ drugs with specific dispensing limits). Verify formulary coverage before prescribing as 40+ brand-name drugs are now excluded from coverage. Update patient counseling protocols to discuss therapeutic alternatives for excluded medications.