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Preferred Drug Strategy for Medical Benefit Drugs with Therapeutic Equivalents or Alternatives To Be Covered Through Enhanced Prior Authorization
Effective date
Jan 1, 2026
Identified
May 3, 2026
Summary
Blue Cross Blue Shield of Texas is implementing enhanced prior authorization for certain medical benefit drugs (including Infliximab, Pegfilgrastim, Rituximab, and Trastuzumab biosimilars) administered in clinical settings. When submitting prior authorization requests for non-preferred drugs, providers will receive a list of preferred therapeutic equivalents or alternatives that must be considered first.
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What to do
Action · 4 steps
01Before January 1, 2026: Review Medical Policy numbers RX501.051, RX502.061, and RX502.030 for specific drug requirements.
02Update prior authorization workflow to include checking the Medical Benefit Therapeutic Alternatives Summary before submitting requests.
03Train clinical staff to consider preferred therapeutic equivalents for Infliximab, Pegfilgrastim, Rituximab, and Trastuzumab biosimilars.
04Always verify eligibility through Availity Essentials prior to drug administration to confirm prior authorization requirements.
Original notice
Preferred Drug Strategy for Medical Benefit Drugs with Therapeutic Equivalents or Alternatives To Be Covered Through Enhanced Prior Authorization
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