CommercialPrior AuthMedium impact
Preferred Drug Strategy for Medical Benefit Drugs with Therapeutic Equivalents or Alternatives To Be Covered Through Enhanced Prior Authorization
BCBS Montana·MT · Oncology, Rheumatology, Gastroenterology +1 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Starting Jan 1, 2026, Blue Cross Blue Shield of Montana will require enhanced prior authorization for certain medical benefit drugs that have therapeutic equivalents or alternatives. When submitting prior auth requests, providers will receive a list of preferred drugs that are clinically appropriate and more cost-effective alternatives.
Action Required
Before Jan 1, 2026: Review the Medical Benefit Therapeutic Alternatives Summary and referenced medical policies (RX501.051, RX502.061, RX502.030) to identify affected drugs including Infliximab, Pegfilgrastim, Rituximab, and Trastuzumab biosimilars. Update prior authorization workflow to expect preferred drug lists when requesting authorization for non-preferred medications. Always check eligibility and benefits through Availity Essentials before rendering services to confirm prior authorization requirements.