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