[Georgia] Pharmacy Policy (Q3 - 2025) Updates January 2026

By January 31, 2026: Billing team must access the full policy documents for each affected medication on CareSource.com (Providers > Tools & Resources > Provider Policies > Georgia Medicaid > Pharmacy) to identify specific coverage criteria, prior authorization requirements, and medical necessity documentation needed. Update billing system rules and claim submission workflows accordingly for all 60+ medications. For archived medications (Casgevy, Jesduvroq, Oxbryta, Tegsedi, Zorbtive), immediately stop processing claims and notify providers that these drugs are no longer covered effective February 1, 2026. For new policies (Alyftrek, Attruby, Aucatzyl, Crenessity, Kebilidi, Nemluvio, Niktimvo, Tryngolza), obtain and implement coverage requirements before the effective date. For revised policies, compare old vs. new criteria using the policy archive to identify workflow changes. Train billing staff and providers on new/changed requirements. Failure to implement these changes will result in claim denials and delayed reimbursement.