All PlansReimbursementMedium impact
Pharmacy Updates
Blue Cross Blue Shield of Vermont·VT · Pharmacy, Endocrinology, Internal Medicine +2 more·Pharmacy
Effective date
Oct 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross VT is implementing multiple pharmacy updates effective October 1, 2026, including new generic tier placements for diabetes medications (Januvia and Janumet as Tier 1 generics) and removal of prior authorization requirements for Bimzelx and Icotyde. Additionally, MD Rx and Community Home Infusion Therapy fee schedules will change on the same date. Billing teams must update formulary references and prior authorization protocols accordingly.
Action Required
By September 30, 2026: (1) Billing team must update pharmacy benefit system to reflect Januvia (sitagliptin) and Janumet (sitagliptin/metformin) as Tier 1 generic medications for diabetes; (2) Remove prior authorization requirements from system rules for Bimzelx and Icotyde—these medications are now preferred and do not require prior auth; (3) Contact provider relations at providerrelations@bcbsvt.com or (888) 449-0443 option 1 to obtain the updated MD Rx and Community Home Infusion Therapy fee schedule, and update fee schedule tables in billing software with new reimbursement rates; (4) Update clinical decision support and formulary lookup tools to reflect new tier assignments and prior auth removals. Consequences: Claims for these medications may be processed incorrectly or denied if system rules are not updated. For questions on drug coverage or clinical considerations, contact Clinical Pharmacist Amy Stoll, PharmD at stolla@bcbsvt.com or (802) 371-3657.