Medical drugs requiring prior authorization
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Lists medical (J/Q/C) drugs that require prior authorization for CareFirst BlueCross BlueShield Community Health Plan Maryland members and maps certain miscellaneous HCPCS/J-codes. Affects providers submitting claims for these listed medical drugs.
No material clinical or coverage changes in this revision.
Coverage Criteria — Medical Drugs Requiring Prior Authorization
Prior Authorization Requirement
Covered when ALL of the following are met:
Providers must obtain prior authorization per plan processes before billing
This listing is an administrative roster of medical drugs that require prior authorization from CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) as of effective 4/1/26. The document does not identify any specific clinical exclusions or any drugs that are exempt from prior authorization; it only enumerates products subject to the prior authorization requirement.
The document is a coverage-listing rather than a clinical policy statement and contains no explicit determinations that any listed drug is not medically necessary. It solely indicates which medical drugs require prior authorization under the CareFirst CHPMD prior authorization list effective 4/1/26.
Coding — Sample and Mapped HCPCS/J-Codes
Provider Actions and Billing Impact
Prior Authorization Required
Prior authorization is required for the medical drugs listed below. Claims for these drugs may be denied or held for review if prior authorization is not obtained. The list is effective 4/1/26 and may be updated by CareFirst CHPMD at any time.
- Effective date: 4/1/26
- Affected drugs: See consolidated drug list in this section
No Step Therapy Rules Listed
This section is a listing of drugs that require prior authorization. No step therapy rules are provided in this policy section.
How to Obtain Authorization
To obtain prior authorization, contact the CareFirst Provider Line or visit the plan website for authorization procedures and required documentation. For provider assistance call the Provider Line at 410-779-9359 or 800-730-8543 and follow the voice prompts; for member help or translator services call 410-779-9369 or 800-730-8530 or visit carefirstchpmd.com.
- Provider Line: 410-779-9359 or 800-730-8543
- Member/translator assistance: 410-779-9369 or 800-730-8530
- Website: carefirstchpmd.com
Background
This resource serves an administrative purpose: to inform providers and billing staff which medical drugs are subject to CareFirst CHPMD prior authorization procedures. The list is effective 4/1/26 and may be updated by the plan at any time; providers should follow the plan’s prior authorization processes when submitting claims for listed drugs.
Definitions
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