MedicaidCoverageMedium impact
[Georgia] April 2026 Pharmacy Policy Updates (5/6)
CareSource·GA · Pharmacy, Internal Medicine, Gastroenterology +4 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 requiring billing team review, while one (Aubagio/teriflunomide) and one (Berinert/C1 esterase inhibitor) underwent annual review with no changes. Specific policy details are not provided in this notification document.
Action Required
By April 30, 2026: Billing team must access the full revised policy documents for the 9 medications with policy changes (Apretude, Bafiertam, Cinryze, Daybue, Doptelet, Elevidys, Empaveli, and Entyvio) on CareSource.com > Providers > Tools & Resources > Provider Policies. Review each revised policy to identify specific changes to prior authorization requirements, coverage criteria, or billing rules. Update billing system rules, prior authorization templates, and clinical staff protocols accordingly. Document changes in internal policy tracking system. Failure to implement policy changes may result in claim denials for affected medications.