MedicaidCoverageMedium impact
[Georgia] Pharmacy Policy Updates August 2025
CareSource·GA · Pharmacy, Rheumatology, Dermatology +8 more·Pharmacy
Effective date
Sep 27, 2025
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is revising pharmacy policies for 47 medications effective September 27, 2025, including new policies for 4 recently FDA-approved drugs (Kisunla, Iqirvo, Leqselvi, Ohtuvayre, and Piasky) and updates to existing specialty drug policies. The billing team must review individual drug policies on CareSource's provider portal to identify specific prior authorization, coverage, and coding changes.
Action Required
By September 27, 2025: Billing team and providers must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Georgia Medicaid and Pharmacy to review all 47 revised/new drug policies. Identify which medications your practice prescribes and document any changes to: (1) prior authorization requirements, (2) coverage criteria, (3) claim modifiers for single-dose vials, and (4) reimbursement rates. Update billing system rules, prior auth workflows, and provider communication materials accordingly. For new drugs (Kisunla, Iqirvo, Leqselvi, Ohtuvayre, Piasky), confirm coverage status and obtain prior authorization processes before patients fill prescriptions. Failure to follow updated policies will result in claim denials for Georgia Medicaid members.