By November 1, 2026: Billing and clinical teams must implement step therapy review requirements for denosumab biosimilars (Bildyos Q5162, Enoby Q5167, Bilprevda Q5162, Xtrenbo Q5167) in the Anthem system; verify that prior authorization requests include documentation of medical necessity. By February 1, 2027: Update billing software and prior authorization workflows to require prior authorization for Immgolis/Immgolis Intri (C9399, J3590), Lytenava (C9399, J3590), and Sarclisa Escena (C9399, J9999); implement quantity limit controls for the same codes; enforce site-of-care restrictions for 10 specialty medications (Avlayah, Boncresa, Enoby, Exdensur, Fesilty, Loargys, Osvyrti, Ponlimsi, Qivigy, Starjemza) under their respective HCPCS codes; and review 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 no longer be medically necessary. Confirm with Carelon Medical Benefits Management for oncology-related Sarclisa Escena requests. Failure to implement prior authorization and quantity limit controls will result in claim denials for non-compliant submissions.