MedicaidPrior AuthHigh impact
[Virginia] Medicaid providers: new PA and step therapy for specialty drugs — action required
Anthem BCBS·VA·Government Programs
We identified it
May 3, 2026
Summary
Virginia Medicaid has implemented new prior authorization and step therapy requirements for specialty drugs. Providers must obtain prior authorization for certain specialty medications and may need to try preferred drugs first before coverage is approved for non-preferred specialty drugs.
Action Required
Immediately: Billing and clinical teams must verify prior authorization requirements for all specialty drug prescriptions for Virginia Medicaid patients. Update workflows to check step therapy protocols before prescribing non-preferred specialty medications. Review current specialty drug claims to ensure compliance with new PA requirements. Contact Virginia Medicaid or check their portal for specific drug lists and step therapy protocols to avoid claim denials.