Medical Drug and Step Therapy Prior Authorization List — Medicare Plus Blue & BCN Advantage (Revised May 2026)
List of medical-benefit drugs subject to prior authorization or step therapy for Medicare Plus Blue and BCN Advantage members and instructions for providers on where to submit requests.
Authorization requirement effective 6/22/2026 added for multiple J- and Q-codes including J2329 (Briumvi) and J3590 (Enoby, Xtrenbo).
Step therapy and preferred biosimilar requirements clarified for several denosumab, tocilizumab, ustekinumab, aflibercept, bevacizumab, filgrastim, eculizumab, and other agents.
Code updates effective 10/1/2025: J1809 Nulibry, J3402 Ryoncil, J3403 Encelto, J7174 Qfitlia, Q5157 Stoboclo.
Authorization requirement removed effective 10/1/2025: J0585 Botox.
Added preferred denosumab biosimilar effective 12/1/2025.
Authorization requirement effective 12/1/2025 for multiple denosumab-related codes including J9011 Datroway and J0897 Xgeva.
Added step therapy criteria for Onivyde and Anktiva effective 12/1/2025.
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