← Back to list
[California] 2027 Medicare formulary changes: Prepare now for
Effective date
Jan 1, 2027
Identified
Nov 3, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross Medicare Advantage plans in California will move 10 brand-name medications to nonformulary status, including common drugs for diabetes, asthma, COPD, anticoagulation, and inflammatory conditions. The practice must proactively review Medicare patients on these medications, coordinate transitions to covered alternatives before year-end, and submit prior authorizations electronically to avoid pharmacy claim denials and treatment delays in January.
Get alerts when payers change rules like this one
We check Anthem BCBS and other payers every day and email you when a change matches your specialty and state.
Get Anthem BCBS alertsPolicy Monitoring is free. No card required.
What to do
Action · 7 steps
01Before January 1, 2027.
02Billing and clinical staff must review the medication lists of all Anthem Blue Cross Medicare Advantage members in California taking Anoro Ellipta, Brilinta, Janumet, Januvia, Jentadueto, Opsumit, Spiriva Handihaler, Stelara (unbranded), Xeljanz/Xeljanz XR, or Xigduo XR.
03Providers should use Real-Time Prescription Benefit (RTPB) in the EHR before e-prescribing to review member-specific coverage and covered alternatives.
04When clinically appropriate, providers must discuss covered alternatives with affected patients and coordinate new prescriptions before the effective date.
05Billing team must update internal tracking to flag these medications and ensure prior authorization requests for any continued use of nonformulary drugs are submitted electronically via https://carelonrx.com/solutions/providers, by phone (833-377-4266), or by fax (844-521-6938) before January 1.
06Front desk and billing staff must be informed of the change so they can help coordinate refill timing and prior auth requirements.
07Claims for these medications without prior authorization will be denied starting January 1, 2027.
Original notice
[California] 2027 Medicare formulary changes: Prepare now for
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Ohio] 2027 Medicare formulary changes: Prepare now forHighEffective Jan 1, 2027 · Pharmacy[New York] 2027 Medicare formulary changes: Prepare now forHighEffective Jan 1, 2027 · Pharmacy[California] New prior authorization requirementsMediumEffective Jan 1, 2027 · Provider Bulletin[California] California 2027 Medicare Advantage plan changesHighEffective Jan 1, 2027 · MedicareBrowse every Anthem BCBS change in the policy list