CommercialCoverageHigh impact
Commercial and Other Pharmacy Program Updates Effective January 1, 2026
Florida Blue·FL·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 16, 2026
Summary
Florida Blue is implementing major pharmacy program changes effective January 1, 2026, including adding 50+ medications to quantity limits, requiring prior authorization for 20+ new drugs, and excluding coverage for numerous brand-name medications. These changes affect preferred drug lists, step therapy requirements, and the Responsible Quantity Program.
Action Required
By January 1, 2026: Billing team must update prior authorization requirements for 20+ new medications including Brekiya, Brinsupri, Brukinsa, Dawnzera, and others listed in the policy. Update pharmacy benefit verification processes to check quantity limits for newly added medications like Amphetamine ER ODT, Auryxia, and Eliquis formulations. Verify coverage exclusions for medications like Bimzelx, Galzin, Myrbetriq brand, and Revlimid brand before prescribing. Update step therapy protocols for antidepressants to include Exxua and escitalopram 15mg. Claims for excluded medications will be denied without therapeutic alternatives.