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Pharmacy Program Updates: Prior Authorization Changes Effective May 1, 2026
Act
by Apr 30, 2026
Effective date
May 1, 2026
Identified
Jun 16, 2026
Summary
Blue Cross Blue Shield of Illinois is updating prior authorization criteria for several pharmacy programs effective May 1, 2026, including changes to Duvyzat, Multiple Sclerosis medications, Ohtuvayre, and Urea Cycle Disorders treatments. Additional therapeutic alternatives will be added to prior authorization requirements starting July 1, 2026.
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What to do
by Apr 30, 2026 · 4 steps
01Clinical staff must review updated prior authorization criteria for Duvyzat, Multiple Sclerosis medications, Ohtuvayre, and Urea Cycle Disorders treatments.
02Update EMR templates to reflect new PA requirements.
03Before July 1, 2026: Review and implement additional therapeutic alternatives PA requirements.
04Monitor BCBSIL website for detailed PA request forms and updated drug lists to ensure proper authorization processes.
Original notice
Pharmacy Program Updates: Prior Authorization Changes Effective May 1, 2026
bcbsil.com · Always check the source before changing claims.
Related changes
See all BCBS Illinois changes →Pharmacy Program Updates: Prior Authorization Changes Effective Jan. 1, 2027HighEffective Jan 1, 2027 · Prior AuthorizationPharmacy Program Updates: Prior Authorization Changes Effective June 15, 2026MediumEffective Jul 1, 2026 · Prior AuthorizationBrowse every BCBS Illinois change in the policy list