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MedicaidCoverageMedium impact

[Georgia] Pharmacy Policy Updates May 2025

CareSource·GA · Dermatology, Rheumatology·Pharmacy
Effective date
Jun 18, 2025
We identified it
May 9, 2026
Days to comply

Summary

CareSource Georgia Medicaid has revised the pharmacy policy for TREMFYA (Guselkumab), effective June 18, 2025. The specific details of the revision are not provided in this notification document; billing teams must access the full policy on CareSource.com to determine what coverage, prior authorization, or reimbursement changes apply.

Action Required

Action needed
By June 17, 2025: Billing team must access the full TREMFYA (Guselkumab) revised policy on CareSource.com (Providers > Tools & Resources > Provider Policies > Georgia > Pharmacy) to identify specific changes. Determine if prior authorization requirements, coverage limitations, or reimbursement rates have changed. Update billing system rules, prior authorization templates, and provider communication accordingly. Notify prescribing providers of any new requirements. Failure to implement changes before the effective date may result in claim denials or processing delays for TREMFYA claims on Georgia Medicaid.

Affected Billing Codes

J3357