CommercialPrior AuthMedium impact
[Georgia] Specialty pharmacy updates — February 2026
Anthem BCBS·GA · Oncology, Hematology, Rheumatology +4 more·Pharmacy
Effective date
May 1, 2026
We identified it
May 18, 2026
Summary
Anthem Georgia is implementing new prior authorization, quantity limit, and step therapy requirements for 14 specialty pharmacy medications effective May 1, 2026. Patients currently receiving these medications without prior authorization will require PA requests going forward. NDC codes should be included on claims to expedite processing of drugs billed with NOC codes.
Action Required
By April 30, 2026: Billing team must update system workflows to require prior authorization for the 14 specialty pharmacy drugs listed (Aukelso, Bildyos, Bilprevda, Bosaya, Enoby, Xtrenbo, Eydenzelt, Gammagard Liquid ERC, Qivigy, Inlexzo, Keytruda Qlex, Forzinity, and Radicava). Update encounter forms and clinical staff workflows to identify when these medications are prescribed. Implement quantity limit checks in billing software for the applicable drugs. Configure step therapy rules marking Gammagard Liquid ERC, Qivigy, and denosumab variants as non-preferred. Ensure NDC codes are captured and included on all claims for these medications to expedite processing. For oncology-related uses (marked with asterisk), coordinate with Carelon Medical Benefits Management for prior authorization review. Train clinical and billing staff on the new requirements. Failure to obtain prior authorization will result in claim denials for dates of service on or after May 1, 2026.