CommercialCoverageMedium impact
Formulary Changes—Select Medical Benefit Drugs Now Available on Pharmacy Benefit—Effective February 1, 2026
CareFirst BlueCross BlueShield·Infectious Disease, OB-GYN, Psychiatry +2 more·Pharmacy
Effective date
Feb 1, 2026
We identified it
Jun 20, 2026
Summary
Effective February 1, 2026, CareFirst is moving select drug classes from medical benefit to pharmacy benefit coverage, including HIV/PrEP long-acting injectables, long-acting contraceptives, and substance use disorder long-acting injectables. This broadens member access and may change how these medications are billed and processed.
Action Required
Before February 1, 2026: Billing team must review the CareFirst formulary changes summary to identify specific medications affected in HIV/PrEP, long-acting contraceptives, and substance use disorder categories. Update billing workflows to process these medications through pharmacy benefit instead of medical benefit. Coordinate with providers to ensure proper prescribing channels are used for affected drug classes.