CommercialPrior AuthMedium impact
Commercial and Other Pharmacy Updates Effective October 1, 2025
Florida Blue·FL · Family Medicine, Internal Medicine, Endocrinology +5 more·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 16, 2026
Summary
Florida Blue is implementing major pharmacy program changes effective October 1, 2025, including new quantity limits for 26 medications, prior authorization requirements for 17 drugs, and coverage exclusions for 8 medications. The Net Results formulary has additional changes with 18 new exclusions and expanded quantity limits.
Action Required
By October 1, 2025: Billing team must update prior authorization workflows for 17 new medications including Andembry, Crenessity, Dexilant, Ekterly, and Zepbound. Update pharmacy benefit verification processes to check quantity limits for medications like hydrocodone-acetaminophen, Nexium, and diabetes supplies. Train staff to verify formulary status before prescribing as 8 medications will no longer be covered and require therapeutic alternatives.