Anthem BCBSHigh 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 clinical settings that require billing through medical claims rather than pharmacy benefits.

Action Required

Immediately: Billing team must access the full policy at the provided URL to identify specific medications and requirements affected. Update prior authorization workflows for medical benefit medications and inform providers of new step therapy requirements. Verify authorization status before administering affected medications to prevent claim denials.

Plan Types

Commercial

States

CA

Specialties

all-specialties