[New York] Quarterly pharmacy formulary change notice

By April 15, 2026: Billing and clinical teams must audit patient medication records to identify members receiving drugs affected by this formulary change. For each affected medication (e.g., CARBINOXAMINE tablets, FAMOTIDINE RX, ELIQUIS formulations, KEYTRUDA QLEX, KOSELUGO, FASLODEX, KOMZIFTI, and all others listed), determine if transition to preferred alternatives is clinically appropriate. Before May 1, 2026: For any patient where formulary alternatives are not clinically appropriate, providers must submit prior authorization requests to Anthem by calling Provider Services at 800-450-8753 (follow pharmacy prior authorization voice prompts) or contact local provider relationship management representatives. Update billing system to flag claims for affected drugs on or after May 1, 2026 that lack documented prior authorization, as these will be denied. Educate front-desk and clinical staff to alert providers to obtain prior authorizations before the effective date. For drugs with new quantity limits (QL) or prior authorization (PA) edits, configure billing software to enforce these limits and require PA submission before claim submission. Reference the updated Preferred Drug List at https://providers.anthem.com/ny for complete details on all formulary changes.