MedImpact GLP-1 prior authorization in 2026.
Roughly 50 million US covered lives in 2026. Used by Many regional Blue Cross Blue Shield affiliates (Blue Shield of California, Premera, Highmark in some products) and others.
Plans administered by MedImpact
- Many regional Blue Cross Blue Shield affiliates (Blue Shield of California, Premera, Highmark in some products)
- Several large state Medicaid managed care plans
- Many smaller commercial plans
The MedImpact step-therapy quirk you should know about
MedImpact is the most variable PBM by plan-affiliate. The same molecule may require step therapy on a Blue Shield CA plan and not on a Premera plan, both administered by MedImpact. Check your specific plan's PA criteria PDF, not a generic MedImpact criteria document.
Expert tip
MedImpact is the largest privately held PBM. Because plan affiliates contract independently, the same MedImpact submission portal serves dozens of different criteria sets. Read the criteria PDF that your specific plan publishes, not the generic MedImpact criteria.
The right plan-by-condition templates for MedImpact
Pick the template that matches your specific health plan and your qualifying indication. The plan and condition determine the PA criteria; the PBM determines how the letter is reviewed and submitted.
Other PBMs
