CommercialPrior AuthHigh impact
[California] Prior authorization and step therapy updates for medications billed under the medical benefit
Anthem BCBS·CA·Provider Bulletin
We identified it
May 3, 2026
Summary
Anthem Blue Cross in California has updated prior authorization and step therapy requirements for medications billed under the medical benefit. This affects medication billing workflows and may require new authorizations for certain drugs previously covered without prior approval.
Action Required
Immediately: Billing team must access the full policy details at the provided URL to identify specific medications affected by new prior authorization requirements. Update billing system alerts for medical benefit drug claims. Verify authorization status before submitting claims for medications under medical benefit to prevent denials.