CommercialPrior AuthHigh impact
Notice of Change for Physician-Administered Drug Program
Florida Blue·FL · Oncology, Neurology, Endocrinology +6 more·Pharmacy
Effective date
Mar 1, 2026
We identified it
Jun 16, 2026
Summary
Florida Blue is expanding their Physician-Administered Drug Program (PADP) effective March 1, 2026, requiring preservice reviews for 25 specific specialty drug codes before administration. Claims will be denied without prior authorization, and providers cannot bill patients for denied charges.
Action Required
By March 1, 2026: Billing team must update system to require preservice review through Prime MPS (gatewaypa.com or 1-800-424-4947) for all 25 listed physician-administered drug codes before administration. Update encounter forms and EMR alerts to remind providers. Claims will be denied without prior authorization and providers cannot bill patients for denied charges.