[Virginia] Specialty pharmacy updates — July 2026
Summary
Anthem Blue Cross and Blue Shield (Virginia) is implementing new prior authorization requirements, quantity limits, and updated clinical criteria for specialty pharmacy drugs effective October 1, 2026. Four drugs now require prior authorization (Fesilty, Loargys, Vykoura, and Leucovorin calcium), two drugs are subject to quantity limits (Loargys and Yuviwel), and eight clinical criteria documents have been updated that may result in previously covered services being denied as not medically necessary. Billing teams must begin requesting prior authorizations for affected specialty pharmacy claims and ensure NDC codes are included on claims using NOC billing codes.
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