CommercialAdministrativeMedium impact
[New York] Unlock updated pharmacy insights today — visit our provider website
Anthem BCBS·NY·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Anthem Blue Cross and Blue Shield is reminding providers to regularly review updated pharmacy information on their provider website, effective July 1, 2026. Drug formularies, prior authorization requirements, and other pharmacy policies are updated quarterly on the first day of January, April, July, and October. Providers must check these resources to ensure members receive accurate drug coverage information and to understand prior authorization, step therapy, and therapeutic interchange requirements.
Action Required
By July 1, 2026: Billing and clinical staff must establish a process to review Anthem's pharmacy updates quarterly on the first day of each quarter (January 1, April 1, July 1, October 1). Assign responsibility to the billing team or clinical staff to access https://anthem.com/provider and https://www.anthem.com/pharmacy-information to review: (1) updated drug formularies and copay/coinsurance changes, (2) prior authorization requirements, (3) step therapy and therapeutic interchange policies, and (4) generic substitution procedures. Update internal protocols and provider order entry systems to reflect any changes in prior authorization requirements or formulary exclusions. For FEP plans, also monitor fepblue.org/pharmacy. For non-internet access, document the process to contact Provider Services using the member ID card number. Failure to stay current with quarterly updates may result in claim denials for non-covered drugs or missing prior authorizations.