MedicaidCoverageHigh impact
[Georgia] Pharmacy Policy (Q2 - 2025) Updates January 2026
CareSource·GA · Ophthalmology, Dermatology, Rheumatology +8 more·Pharmacy
Effective date
Feb 1, 2026
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is updating pharmacy policies for 47 medications effective February 1, 2026. Most updates are policy revisions affecting existing drugs (botulinum toxins, monoclonal antibodies, ophthalmologic agents, oncology treatments), with 8 new policies added for recently approved medications. Billing teams must review individual drug policies for changes to prior authorization requirements, coverage criteria, and medical necessity documentation.
Action Required
By January 31, 2026: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Georgia Medicaid, and review the specific pharmacy policy details for each of the 47 updated medications listed in this notification. For revised policies, identify any changes to prior authorization triggers, dosing limits, or medical necessity criteria. For new policies (AQNEURSA, EBGLYSS, LIVDELZI, MIPLYFFA, NEMLUVIO, NIKTIMVO, VIJOICE, XEOMIN, YORVIPATH), determine if prior authorization is required before claims are submitted. Update billing software rules, prior auth workflows, and provider order entry systems as needed for each drug. Communicate changes to prescribing providers and clinical staff. Failure to implement updated requirements will result in claim denials or delays for affected medications beginning February 1, 2026.