By November 30, 2026: Billing and clinical teams must update systems and workflows to require prior authorization for specialty pharmacy claims using HCPCS codes C9399, J3590, and J9999. Specifically: (1) Configure billing software to mandate prior authorization submission for Saphnelo, Hepcludex, Decnupaz, Lumvoa, and Trutakna before claim submission; (2) Update encounter templates and provider documentation checklists to prompt for medical necessity information, as certain medications require additional documentation; (3) Implement quantity limit monitoring in billing system for Saphnelo, Lumvoa, and Trutakna; (4) Train providers to include National Drug Code (NDC) on all specialty pharmacy claims to expedite processing; (5) Reference updated Clinical Criteria documents (CC-0202, CC-0303, CC-0304, CC-0305, CC-0306, and revisions to CC-0057, CC-0077, CC-0099, CC-0112, CC-0119, CC-0125, CC-0162, CC-0237, CC-0243, CC-0276, CC-0281) when determining medical necessity. Note: Oncology use of Decnupaz is managed by Carelon Medical Benefits Management, not Anthem. Failure to obtain prior authorization as of December 1, 2026, will result in claim denials for affected specialty pharmacy medications.