By November 15, 2026: Billing team must update systems to require prior authorization submission for all claims dated on or after December 1, 2026 containing HCPCS codes C9399, J3590, or J9999 (specialty pharmacy drugs: Saphnelo, Hepcludex, Decnupaz, Lumvoa, and Trutakna). For quantity limit drugs (Saphnelo, Lumvoa, Trutakna), configure system to flag claims exceeding approved quantities. Notify all providers that patients currently receiving these medications without prior authorization will need new PA requests submitted before December 1, 2026 for continued coverage. Include NDC codes on all specialty pharmacy claims to expedite processing. Review the revised clinical criteria (CC-0057, CC-0077, CC-0099, CC-0112, CC-0119, CC-0125, CC-0162, CC-0237, CC-0243, CC-0276, CC-0281) for Krystexxa, Palynziq, Abraxane, Xofigo, Yervoy, Opdivo, Tepezza, Qalsody, Vyjuvek, Tryngolza, and Opdivo Qvantig, as previously approved therapies may now be deemed not medically necessary and require new authorization. Claims without required prior authorization will be denied. For oncology use of Decnupaz, route prior authorization requests to Carelon Medical Benefits Management, not Anthem's medical specialty drug review team.