MedicaidCoverageMedium impact
[Georgia] April 2026 Pharmacy Policy Updates (3/6)
CareSource·GA · Pharmacy, Rheumatology, Dermatology +3 more·Pharmacy
Effective date
May 1, 2026
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is updating pharmacy policies for 10 medications effective May 1, 2026. Nine drugs have revised policies (Cimzia, Egrifta SV/WR, inhaled prostacyclins, Leqselvi, Litfulo, Olumiant, Skyrizi, Tremfya, and Xeljanz/Xeljanz XR), while Sylvant is a new policy addition. Billing teams must review the full policy details on CareSource.com to understand specific coverage, prior authorization, and billing requirements for each medication.
Action Required
By April 30, 2026: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Georgia Medicaid, then Pharmacy to review the complete policy details for each of the 10 updated/new medications (Cimzia, Egrifta SV/WR, inhaled prostacyclins, Leqselvi, Litfulo, Olumiant, Skyrizi, Sylvant, Tremfya, and Xeljanz/Xeljanz XR). Update billing software, prior authorization requirements, and staff training materials to reflect any changes in coverage criteria, prior auth thresholds, or documentation requirements. Document changes in internal policy files and communicate updates to clinical staff and pharmacy liaisons. Failure to implement changes by May 1, 2026 may result in claim denials or payment delays for these medications.