Medicare AdvantagePrior AuthHigh impact
Medicare Part B Step Therapy Product Updates
Florida Blue·FL · Oncology, Rheumatology, Endocrinology +5 more·Medicare
Effective date
Jan 1, 2026
We identified it
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.
Action Required
Before January 1, 2026: Billing team must update prior authorization systems to reflect new step therapy requirements for all listed drug categories. Update billing software to flag non-preferred products requiring step therapy trials. Train clinical staff on new preferred drug alternatives. Implement workflow to verify step therapy compliance before submitting claims for non-preferred medications. Claims for non-preferred drugs without proper step therapy documentation will be denied.