CommercialAdministrativeMedium impact
[California] Unlock updated pharmacy insights today — visit our provider website
Anthem BCBS·CA · Pharmacy·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Anthem Blue Cross (California) is notifying providers to review updated pharmacy information on their provider website. Effective July 1, 2026, commercial and exchange drug lists will be posted quarterly (January, April, July, October). Providers must monitor changes to copay/coinsurance requirements, prior authorization needs, step therapy, therapeutic interchange, and generic substitution procedures to ensure accurate billing and member access.
Action Required
By July 1, 2026: Billing team and providers must establish a quarterly review process (first day of January, April, July, and October) to check https://anthem.com/ca/provider for updated Anthem Blue Cross pharmacy information. Specifically monitor for changes to: (1) copay/coinsurance amounts by drug class, (2) prior authorization requirements, (3) step therapy and therapeutic interchange protocols, and (4) formulary changes. Update billing system rules and EMR templates to reflect new prior auth requirements and copay amounts. For exception requests or preapproval submissions, direct to carelonrx.com/solutions/providers. For FEP plans, monitor fepblue.org/pharmacy. Failure to implement updated prior auth requirements will result in claim denials and delayed member access to medications.