MedicaidCoverageMedium impact
[Georgia] Pharmacy Policy Updates April 2025
CareSource·GA · Ophthalmology, Psychiatry, Pharmacy·Pharmacy
Effective date
May 1, 2025
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is revising pharmacy policies for two medications effective May 1, 2025: Aflibercept (Eylea, Eylea HD, Pavblu) and Spravato (Esketamine). The document is a network notification directing providers to review updated policies online but does not specify what the actual policy revisions entail.
Action Required
By April 30, 2025: Billing and clinical teams must access the full revised policies for Aflibercept (Eylea, Eylea HD, Pavblu) and Spravato (Esketamine) on CareSource.com (Providers > Tools & Resources > Provider Policies > Georgia > Pharmacy). Review changes in prior authorization requirements, coverage criteria, reimbursement rates, or billing procedures. Update billing system rules, prior authorization templates, and provider education materials accordingly. Communicate changes to prescribers and injection/infusion staff. Claims submitted after May 1, 2025 must comply with revised policy terms or risk denial.