MedicaidCoverageMedium impact
[Georgia] April 2026 Pharmacy Policy Updates (1/6)
CareSource·GA · Pharmacy, Rheumatology, Hematology +4 more·Pharmacy
Effective date
May 1, 2026
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is releasing 10 pharmacy policy updates effective May 1, 2026, including 5 new policies (Adalimumab, Andembry, Ekterly, Sephience, Yeztugo) and 5 revised policies (Gender Identity Hormone Therapy, Hemophilia and Other Clotting Disorders, Mavyret, Ustekinumab, Zeposia). Billing teams must review each policy to understand prior authorization requirements, coverage criteria, and any documentation changes for these medications.
Action Required
By April 30, 2026: Billing team and providers must review all 10 pharmacy policies on CareSource.com (Providers > Tools & Resources > Provider Policies > Georgia > Pharmacy) to identify prior authorization requirements, coverage restrictions, and documentation needs for each medication. Update billing system rules and prior authorization workflows for Adalimumab, Andembry, Ekterly, Gender Identity Hormone Therapy, Hemophilia/Clotting Disorders, Mavyret, Sephience, Ustekinumab, Yeztugo, and Zeposia. Notify prescribing providers of any new prior authorization requirements. Claims submitted without required prior authorization or missing documentation will be denied.