Medicare AdvantagePrior AuthHigh impact
Updated Categories for Medicare Advantage Part B Step Therapy
Florida Blue·FL · Oncology, Allergy & Immunology, Hematology +1 more·Medicare
Effective date
Jul 15, 2026
We identified it
Jun 30, 2026
Summary
Florida Blue Medicare updated its Part B Step Therapy program effective July 15, 2026, reclassifying certain cancer supportive therapy and immune globulin products from preferred to non-preferred (requiring step therapy), while moving a limited number of products to preferred status. Billing teams must update prior authorization requirements and preferred drug lists in their systems to reflect these changes.
Action Required
By July 15, 2026: Billing team must update all billing system rules and prior authorization protocols to reflect the new Part B Step Therapy categories for Florida Blue Medicare Advantage plans. Specifically: (1) Move the following products to non-preferred status requiring step therapy prior authorization: Fusilev (J0641), Khapzory (J0642), Vykoura (J3490), Belrapzo (J9036), Bendeka (J9034), Treanda (J9033), Vivimusta (J9056), Alyglo (J1599), Asceniv (J1554), Bivigam (J1556), Gammagard S/D (J1566), Cuvitru (J1555), and Xembify (J1558); (2) Move the following products to preferred status: Panzyga (J1576), Yimmugo (J3590), and Qivigy (J1577). Update encounter forms and provider communication templates to reflect preferred alternatives. Update claim submission rules to automatically flag non-preferred codes for prior authorization verification before submission to Florida Blue. Providers must obtain prior authorization before administering or prescribing non-preferred products; claims submitted without proper authorization will be denied. Inform all oncology and infusion-based specialties of these changes immediately.