MedicaidCoverageMedium impact
[Georgia] April 2026 Pharmacy Policy Updates (4/6)
CareSource·GA · Pharmacy, Infectious Disease, Neurology +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. Most policies are revised (APRETUDE, BAFIERTAM, CINRYZE, DAYBUE, DOPTELET, ELEVIDYS, EMPAVELI, ENTYVIO), while two undergo annual review with no updates (AUBAGIO, BERINERT). Billing teams must review individual policy documents for specific coverage criteria, prior authorization requirements, and any changes to reimbursement or documentation standards.
Action Required
By April 30, 2026: Billing team must access and review each revised pharmacy policy on CareSource.com (Providers > Tools & Resources > Provider Policies > Georgia Medicaid > Pharmacy) for the 8 revised medications. Document any changes to prior authorization requirements, coverage criteria, or documentation standards. Update billing system rules and provider communication materials accordingly. Flag policies with new prior auth requirements for provider notification before May 1, 2026. Failure to implement policy changes may result in claim denials for non-compliant submissions.