Medical benefit drug policy list

Effective January 1, 2026, oncology-related medications for Commercial and Medicare Part B may be subject to updated prior authorization requirements. Visit the Evolent website to review the oncology-related medications policies.

Blue Shield Medicare plans follow Medicare guidelines for risk allocation and Medicare national and local coverage guidelines. If there is not a fully established or there is an absence of any applicable Medicare statute, regulation, guideline, Blue Shield Medicare medication policies will be used to determine medical necessity.

View the Blue Shield Medicare Part B medication policies:

• Part B medication policies

Part B drugs may be subject to step therapy. View the Part B Step Therapy criteria:

• Medicare PPO Part B step therapy criteria (PDF, 134 KB)