Summary
Effective July 1, 2026, Blue Cross Vermont is implementing major pharmacy formulary changes affecting 40+ brand-name medications moving to excluded status (with generic alternatives available), 10 products with new quantity limits, 3 drugs requiring new prior authorization, and 6 medications with new step therapy requirements. Billing and clinical teams must immediately identify affected patients and update prior authorization workflows to prevent claim denials.
Get alerts when payers change rules like this one
We check Blue Cross Blue Shield of Vermont and other payers every day and email you when a change matches your specialty and state.
Get Blue Cross Blue Shield of Vermont alertsPolicy Monitoring is free. No card required.
What to do
by Jun 15, 2026 · 7 steps
01Billing and clinical teams must audit patient medication lists to identify those currently on any of the 40+ newly excluded medications (e.g., Aptiom, Brilinta, Pradaxa, Lyrica, Entresto, Lovenox, Kenalog-10, Nexavar, Tasigna, Victoza, Spiriva, Rytary, Tikosyn, Premarin, Promacta, Korlym, Iressa, and others listed).
02Pharmacy and clinical staff must proactively contact prescribers and patients to transition to generic formulations or specified alternatives BEFORE July 1 to avoid prior-fill claim denials.
03Billing system must be updated to flag and require prior authorization for: Arbli (losartan) suspension, Depen (penicillamine) tablets, and Lopressor (metoprolol) solution.
04Add step therapy requirements in system for: Auryxia, Dymista, Nuvaring (BCBSVT only), Spiriva (BCBSVT only, includes QL), Tiglutik, and Zoryve.
05Implement quantity limits in billing software for: Albendazole, Biltricide, Emverm, Esbriet, Ivermectin (tablets and Stromectol), Leqembi, Ofev, sodium hyaluronate products, Votrient, and Xdemvy.
06Update encounter forms and prior authorization templates with new requirements.
07Brief front desk staff to anticipate patient questions about coverage changes.
If missed: Failure to implement these changes will result in claim denials, delayed patient access to medications, and potential patient appeals.
Original notice
Pharmacy Updates
bluecrossvt.org · Always check the source before changing claims.