By November 1, 2026: Billing and clinical staff must implement step therapy review requirements for denosumab products (Bildyos, Enoby, Bilprevda, Xtrenbo) using HCPCS codes Q5162, Q5167 in the billing system. By February 1, 2027: (1) Billing team must update the billing system to require prior authorization for specialty pharmacy claims using HCPCS codes C9399, J3590, J9999 and specific drugs listed (Immgolis, Immgolis Intri, Lytenava, Sarclisa Escena); (2) Implement quantity limit controls for the same medications on claims with dates of service on or after February 1, 2027; (3) Apply site-of-care restrictions for 10 specialty drugs (Avlayah, Boncresa, Enoby, Exdensur, Fesilty, Loargys, Osvyrti, Ponlimsi, Qivigy, Starjemza) using specified HCPCS/CPT codes; (4) Review revised Clinical Criteria CC-0001, CC-0027, CC-0048, CC-0058, CC-0062, CC-0068, CC-0072, CC-0075, CC-0104, CC-0107, CC-0124, CC-0127, CC-0142, CC-0156, CC-0161, CC-0165, CC-0167, CC-0228, CC-0242, CC-0244, CC-0266, CC-0247, CC-0310 as previously covered services may now be denied as not medically necessary. Note: Oncology claims for Sarclisa Escena are managed by Carelon Medical Benefits Management. Claims lacking required prior authorization or not meeting new criteria may be denied.