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Florida BlueCommercial · Prior Auth · Pharmacy · PharmacyHigh impact

Commercial and Other Pharmacy Program October 1 Updates

Effective date
Oct 1, 2026
Identified
Sep 2, 2026

Summary

Florida Blue's commercial and other pharmacy program changes take effect October 1, 2026. Drugs are added to the Responsible Quantity Program with per-month dispensing limits, and those limits also apply to generic drugs for members whose plans are part of that program. Brand and generic drugs are added to the pharmacy coverage exclusions list, prior authorization requirements change for other listed drugs, and the Net Results formulary has its own exclusions, prior authorization additions, quantity limits and step therapy changes.

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What to do

Action · 4 steps
01Already effective October 1, 2026: Check the current applicability of these pharmacy changes for each patient's plan, because the Responsible Quantity Program, Prior Authorization Program and Net Results changes apply only to members whose plans are part of those programs.
02For drugs on the Prior Authorization Program lists, prior authorization requirements change for the listed FDA approved indications, and the summary of criteria is available with the authorization forms.
03For drugs on the new coverage exclusion lists, the drugs are no longer covered for members enrolled in health plans that allow pharmacy coverage exclusions.
04Verify patients' eligibility and pharmacy benefits in Availity Essentials at essentials.availity.com, and call the Provider Contact Center at 1-800-727-2227 with questions about Florida Blue benefits or these pharmacy updates.

Original notice

Commercial and Other Pharmacy Program October 1 Updates
files.guidewell.com · Always check the source before changing claims.
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