Anthem BCBSMedium ImpactPrior Auth

[California] Prior authorization and step therapy updates for medications billed under the medical benefit

Published May 3, 2026

AI Summary

Anthem California has updated prior authorization and step therapy requirements for medications billed under the medical benefit. This affects medications administered in medical offices and billed through medical claims rather than pharmacy benefits.

Action Required

Immediately: Billing team must review the full policy bulletin at the provided URL to identify specific medications with new prior authorization requirements. Update billing system to flag affected medications for prior auth verification before administration. Train staff on new step therapy protocols that may require trying alternative medications first.

Plan Types

Commercial

States

CA

Specialties

all-specialties