CommercialPrior AuthMedium impact
[Virginia] New specialty pharmacy medical step therapy requirements
Anthem BCBS·VA·Pharmacy
We identified it
May 30, 2026
Summary
Anthem Virginia has implemented new step therapy requirements for specialty pharmacy medications, requiring patients to try and fail on lower-cost alternatives before coverage is approved for certain specialty drugs. This affects prior authorization processes and may delay treatment approvals for specialty medications.
Action Required
Immediately: Billing and clinical teams must verify step therapy requirements before prescribing specialty medications for Virginia Anthem members. Update prior authorization workflow to check if patients have tried required lower-tier medications first. Inform providers to document previous medication trials and failures when requesting specialty drug approvals to avoid delays and denials.