CommercialPrior AuthMedium impact
[Georgia] Specialty pharmacy updates — July 2026
Anthem BCBS·GA · Oncology, Pharmacy·Pharmacy
Effective date
Oct 1, 2026
We identified it
Jun 27, 2026
Summary
Effective October 1, 2026, Anthem Blue Cross and Blue Shield is implementing new step therapy requirements for specialty pharmacy medications, specifically nivolumab (Opdivo) products. Patients currently receiving these medications without prior authorization will now require prior authorization review for continued use. Two formulations are affected: nivolumab (J9299, preferred) and nivolumab hyaluronidase-nvhy (J9289, non-preferred).
Action Required
Before October 1, 2026: (1) Billing team must update billing system and prior authorization workflows to require step therapy review for HCPCS codes J9299 (Opdivo/nivolumab) and J9289 (Opdivo Qvantig/nivolumab hyaluronidase-nvhy) for all Anthem Georgia commercial plans. (2) Oncology providers must review Clinical Criteria documents CC-0125 and CC-0281 to understand step therapy requirements and communicate with patients about potential authorization delays. (3) Update encounter templates and prior authorization submission processes to flag these codes for mandatory review. (4) Notify current patients on nivolumab therapy that prior authorization will be required for refills after the effective date. Claims submitted without obtaining required prior authorization will be denied.