MedicaidPrior AuthMedium impact
[California] Prior authorization and step therapy updates for medications billed under the medical benefit
Anthem BCBS·CA · Oncology, Ophthalmology, Endocrinology·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem Blue Cross California is implementing new prior authorization requirements for 6 specialty pharmacy drugs billed under medical benefits, and adding step therapy requirements for Nufymco (ranibizumab-leyk). These changes affect Medicaid patients and require NDC codes on medical claims for processing.
Action Required
Before August 1, 2026: Billing team must update system to require prior authorization for Boncresa, Lerochol, Nufymco, Oziltus, Rybrevant Faspro, and Yartemlea when billed on medical claims for Medicaid patients. Ensure all medical claims include NDC codes for specialty pharmacy drugs. Providers must obtain prior authorization for patients currently receiving these medications to continue treatment after the effective date. Flag Nufymco as non-preferred requiring step therapy review.