By November 1, 2026: Billing and clinical teams must implement step therapy review requirements for denosumab biosimilar codes (Q5162, Q5167) and associated medications per Clinical Criteria CC-0027 and CC-0310. By February 1, 2027: Billing team must update billing system and prior authorization workflows to require prior authorization requests for specialty pharmacy medications including golimumab-sldi (C9399, J3590), bevacizumab-vikg (C9399, J3590), and isatuximab-irfc (C9399, J9999) per updated Clinical Criteria. Implement quantity limit controls for the same medications effective February 1, 2027. Configure site-of-care review requirements for 10 specialty medications with specified HCPCS codes (J1757, Q5171, Q5167, J2361, J7176, J1818, Q5166, Q5173, J1577, Q5164) effective February 1, 2027. Review all revised Clinical Criteria documents (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) to identify services that may now be found not medically necessary. Note that oncology medications managed by Carelon Medical Benefits Management may require additional documentation to establish medical necessity. Without prior authorization, claims for affected medications will be subject to denial.