[Georgia] Pharmacy Policy Updates February 2026

By February 28, 2026: Billing team must access the full CareSource policy documents for each affected medication at CareSource.com > Providers > Tools & Resources > Provider Policies to identify specific clinical criteria, prior authorization requirements, and documentation needs for the 11 new policies and 47 revised policies. For all providers prescribing these medications to Georgia Medicaid members, update internal protocols and staff training on any new or modified requirements. For the 11 NEW POLICIES (Buprenorphine Extended-Release, CTEXLI, Encelto, ERT for Gaucher Disease, Gomekli, Imaavy, Medical Benefit Medications, Romvimza, Vanrafia, Vykat XR, Zevaskyn): obtain and review full policy text before March 1 to understand initial coverage criteria. For the 47 REVISED POLICIES: compare prior versions (available in policy archive) to identify what clinical criteria or requirements changed. Implement any new prior authorization processes in billing software, update claim submission workflows, and brief clinical staff on documentation requirements. Failure to comply with new requirements will result in claim denials for Georgia Medicaid members.