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Submitting a Prior Authorization Request for a Pharmacy Prescription Drug
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Sep 26, 2026
Summary
Horizon Blue is transitioning pharmacy prior authorization submissions to electronic Prior Authorization (ePA) through vendors like CoverMyMeds or SureScripts. Beginning January 1, 2027, New Jersey State Mandate will require ePA for all pharmacy prescription drug prior authorization requests (formulary exceptions, tier exceptions, quantity limit reviews).
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What to do
by Dec 31, 2026 · 5 steps
01Billing team and prescribing providers must transition all pharmacy prior authorization submissions to electronic ePA (ePA) through CoverMyMeds.health or SureScripts.com.
02Update internal workflows and staff training to require ePA for formulary exception (FE), tier exception (TE), prior authorization (PA), and quantity limit (QL) review requests.
03Paper or phone-based pharmacy prior authorization submissions will no longer be accepted after January 1, 2027.
04Implement system integration with ePA vendors if not already in place.
05Verify all relevant staff have vendor portal access and training completed before the effective date.
If missed: Failure to submit ePA may result in delayed or denied pharmacy claims.
Original notice
Submitting a Prior Authorization Request for a Pharmacy Prescription Drug
horizonblue.com · Always check the source before changing claims.
Related changes
See all Horizon BCBS NJ changes →Submit Prior Authorization for Your Patient's Medications Quickly and Easily Using ePAMediumEffective Jan 1, 2027 · Prior AuthorizationSubmitting a Prior Authorization Request for a Pharmacy Prescription DrugMediumEffective Jun 1, 2026 · Prior AuthorizationBrowse every Horizon BCBS NJ change in the policy list