Medicare AdvantagePrior AuthHigh impact
Medicare Part B Step Therapy Oct Updates
Florida Blue·FL · Oncology, Rheumatology, Hematology +3 more·Medicare
Effective date
Oct 1, 2026
We identified it
Sep 25, 2026
Summary
Florida Blue Medicare has updated its Part B Step Therapy program effective October 1, 2026, restructuring preferred and non-preferred medication classifications across six drug categories (Autoimmune Therapy, Bone Remodeling Agents, Cancer and Supportive Therapy, Colony-Stimulating Factors, Complement Inhibitors, and Ophthalmic Agents). Billing teams must verify that prescriptions align with updated preferred product lists and implement prior authorization requirements for non-preferred medications to prevent claim denials.
Action Required
By September 30, 2026: Billing team must update the claims processing system to enforce the revised Part B Step Therapy preferred/non-preferred product classifications across all six drug categories (Autoimmune Therapy, Bone Remodeling Agents, Cancer and Supportive Therapy, Colony-Stimulating Factors, Complement Inhibitors, and Ophthalmic Agents). Configure the system to automatically flag and require prior authorization for all non-preferred HCPCS codes listed in the policy before processing claims. Providers must be notified of preferred product alternatives to facilitate prescribing decisions. Update denial management protocols to reflect the new classifications. Failure to implement these changes will result in claim rejections and denials for non-compliant prescriptions effective October 1, 2026.