Medicare AdvantagePrior AuthHigh impact
Updated Categories for Medicare Advantage Part B Step Therapy
Florida Blue·FL · Rheumatology, Oncology, Ophthalmology +1 more·Medicare
Effective date
Sep 15, 2025
We identified it
Jun 16, 2026
Summary
Florida Blue Medicare updated its Part B Step Therapy program effective September 15, 2025, adding new non-preferred drugs to four categories that now require step therapy and prior authorization. Billing teams must ensure preferred alternatives are tried first or obtain prior authorization for the newly added non-preferred medications.
Action Required
By September 15, 2025: Billing team must update prior authorization requirements for all newly added non-preferred drugs in the four categories (autoimmune therapy, bone remodeling agents, cancer/supportive therapy, and ophthalmic agents). Update billing system to flag these codes for step therapy verification. Providers must prescribe preferred alternatives first or obtain prior authorization for non-preferred drugs to avoid claim denials.