CommercialPrior AuthHigh impact
AB2026-05-004 Pharmacy updates
Capital Blue Cross·Oncology, Cardiology, Ophthalmology +8 more·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross is updating their formularies effective July 1, 2026, adding 12-13 newly marketed drugs (many requiring prior authorization and quantity limits), expanding prior authorization requirements to 26 existing medications, and implementing new quantity limits on HIV/AIDS medications and other drugs.
Action Required
By July 1, 2026: Update prior authorization workflows for 26 medications including ALKINDI SPRINKLE, ALLOPURINOL, ALPHAGAN P, AZOPT, and others listed. Implement quantity limit restrictions for HIV medications and newly marketed specialty drugs. Train staff on new formulary tiers and prior auth requirements. Update patient eligibility verification to check formulary status before prescribing. Failure to obtain required prior authorizations will result in claim denials.