If you are a NY provider that accepts bcbs highmark members in your practice, then this blog post is for you!

Which Plans are affected?

• Managed Medicaid
• Child Health Plus
• Essential
• HARP

What is changing?

The following medications that are covered under the medical benefit will require prior authorization, effective 4/1/26.

Which Medications are effected?

Billing: NDC# is required for any medical claim submitted for these meds.

If your patient current receives any of these medications without and authorization. Your office will need to contact the plan for a prior authorization.

For more information about prior auth criteria visit https://www.carelonrx.com/ms/pharmacyinformation/clinicalcriteria.html

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