CommercialPrior AuthMedium impact
Pharmacy Program Updates: Prior Authorization Changes Effective June 1, 2026
BCBS Illinois·IL·Prior Authorization
Effective date
Jun 1, 2026
We identified it
Jun 16, 2026
Summary
Blue Cross Blue Shield of Illinois is implementing multiple pharmacy prior authorization changes through Prime Therapeutics, including a new program for Cardamyst effective June 1, 2026, and criteria updates for Fintepla, Vascepa, and Alternative Dosage Forms through August 2026.
Action Required
By June 1, 2026: Billing team must obtain prior authorization for Cardamyst prescriptions for BCBS IL members with Prime Therapeutics pharmacy benefits. By June 15, 2026: Review updated criteria for Vascepa prior authorization. By July 1, 2026: Review updated criteria for Fintepla prior authorization. By August 1, 2026: Review updated criteria for Alternative Dosage Form prior authorization. Update provider workflows to check PA requirements before prescribing these medications to avoid claim denials.