CommercialPrior AuthMedium impact
[New York] Expansion of the specialty pharmacy precertification list
Anthem BCBS·NY·Pharmacy
We identified it
May 3, 2026
Summary
Anthem has expanded their specialty pharmacy precertification list in New York, adding new medications that now require prior authorization before dispensing. This affects billing for specialty drugs that previously did not need precertification.
Action Required
Immediately: Billing team must review the expanded precertification list at the source URL to identify newly added specialty medications. Update prior authorization tracking system to flag these medications. Notify providers to obtain precertification before prescribing newly listed specialty drugs. Verify precertification status before submitting pharmacy claims to avoid denials.