CommercialPrior AuthHigh impact
CVS Specialty To Cease Prior Auth Reviews for Commercial Members
Florida Blue·FL·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 16, 2026
Summary
Effective January 1, 2026, CVS Specialty will no longer handle prior authorization reviews for Florida Blue commercial and Truli for Health members. Prior authorization requests must now be submitted to different entities depending on medication type: Prime Therapeutics for self-administered drugs, Availity Essentials for hemophilia and provider-administered medications, and GatewayPA for PADP program medications.
Action Required
By January 1, 2026: Billing team must update prior authorization submission workflows for Florida Blue commercial and Truli for Health members. Redirect self-administered medication prior auths to Prime Therapeutics at CoverMyMeds, hemophilia medications to Availity Essentials, provider-administered medications to Availity Essentials, PADP program medications to GatewayPA, and home health/DME to CareCentrix. Update staff training materials and billing system routing. Failure to submit to correct entity will delay medication approvals.