CommercialPrior AuthMedium impact
Pharmacy news roundup
BCBS Michigan·MI · Pharmacy, Endocrinology·Pharmacy
Effective date
Jul 1, 2026
We identified it
Aug 26, 2026
Summary
This is a pharmacy news roundup from Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) announcing multiple prior authorization requirements for specialty pharmacy drugs (Blenrep, Tregzi, Lumvoa IV) effective July-October 2026, plus new Medicare GLP-1 weight loss coverage eligibility starting July 1, 2026. The billing team must implement prior authorization workflows for these drugs and monitor for GLP-1 coverage changes.
Action Required
Before July 1, 2026: Billing team must (1) Review detailed prior authorization requirements for Blenrep (effective Oct 7), Tregzi (effective July 13 and Aug 3), and Lumvoa IV (effective July 13 and Aug 3) via BCBSM provider portal at availity.com; (2) Update billing system and pharmacy workflows to require prior authorization for these specialty drugs for Blue Cross commercial and most members; (3) Notify providers and pharmacy staff of new requirements; (4) Educate front-desk and billing staff on GLP-1 Medicare coverage eligibility changes effective July 1, 2026. Subscribe to Provider Alerts Weekly for ongoing updates. Failure to obtain prior authorization will result in claim denials. Contact HelpScript for questions regarding implementation.