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Medicare Part B Step Therapy Product Updates
Effective date
Jan 1, 2026
Identified
Jun 16, 2026
Summary
Florida Blue Medicare updated its Part B Step Therapy programs for Medicare Advantage plans, effective January 1, 2026. Multiple drug categories now have new preferred and non-preferred medications, requiring step therapy trials of preferred products before non-preferred drugs can be approved.
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What to do
Action · 5 steps
01Before January 1, 2026: Billing team must update prior authorization systems to reflect new step therapy requirements for all listed drug categories.
02Update billing software to flag non-preferred products requiring step therapy trials.
03Train clinical staff on new preferred drug alternatives.
04Implement workflow to verify step therapy compliance before submitting claims for non-preferred medications.
05Claims for non-preferred drugs without proper step therapy documentation will be denied.
Codes mentioned
J0702J1010J1100J1720J2919J3301J3303J0801J0802Q5103J1745Q5104J1748Q5121Q9998Q5099J3358Q5098Q9999Q9997J3590C9399Q5138Q5100J3489Q5136Q5157J0897J3111Q5158Q5159J1626J2405J2469J1627J2468J1453J1434J0185J0640J0641J0642Q5107Q5118J9035Q5126Q5129J9999Q5117Q5114Q5116J9355J9356Q5146Q5113Q5112Q5115Q5119Q5123J9312J9310J9311J9036J9034J9033J9206J9205Q5108Q5111Q5130J2506J1449Q5127J9361Q5148Q5120Q5122J1447Q5101Q5110J1442Q5125J2820J1303J9332J9334J9333Q5151J1300J1299J1307Q5152J3490J1823J3396Q5124Q5128J0178J0177J2778J2777Q5147Q5149Q5150Q5153Q5155J0179J2779C9257
Original notice
Medicare Part B Step Therapy Product Updates
files.guidewell.com · Always check the source before changing claims.
Related changes
See all Florida Blue changes →Medicare Part B Step Therapy Oct UpdatesHighEffective Oct 1, 2026 · MedicareUpdated Categories for Medicare Advantage Part B Step TherapyHighEffective Sep 15, 2025 · MedicareNew Drug Waste Reduction GuidelineHighEffective Jun 1, 2026 · PharmacyMedicare Part B Step Therapy Product UpdatesMediumEffective Jul 15, 2025 · MedicareBrowse every Florida Blue change in the policy list
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