MedicaidCoverageMedium impact
[Georgia] April 2026 Pharmacy Policy Updates (2/6)
CareSource·GA · Pharmacy, Rheumatology, Dermatology +5 more·Pharmacy
Effective date
May 1, 2026
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is revising pharmacy policies for 10 specialty medications effective May 1, 2026. These are revised policies (not new) affecting biologics and specialty drugs including AJOVY, DUPIXENT, GAMIFANT, IMMUNE GLOBULIN, KISUNLA, NITISINONE, NUCALA, OTEZLA, RIVFLOZA, and SKYTROFA. The document provides notice of the changes but does not specify what was revised in the policies themselves.
Action Required
By April 30, 2026: Billing team must review the full revised pharmacy policies for all 10 affected medications on CareSource.com (Providers > Tools & Resources > Provider Policies > Select Georgia Medicaid > Pharmacy). Identify specific changes to prior authorization requirements, coverage criteria, or reimbursement terms for each drug. Update billing system rules, prior authorization templates, and provider documentation requirements accordingly. Communicate any new prior auth triggers or coverage restrictions to prescribing providers. Failure to implement changes before May 1, 2026 may result in claim denials for affected medications.