By November 1, 2026: Billing team must implement step therapy review requirements for denosumab biosimilars (Bildyos Q5162, Enoby Q5167, Bilprevda Q5162, Xtrenbo Q5167) in the billing system. By February 1, 2027: Billing team must update the prior authorization workflow to require authorization requests for specialty pharmacy medications including Immgolis (C9399, J3590), Lytenava (C9399, J3590), and Sarclisa Escena (C9399, J9999); implement quantity limit controls for Immgolis and Lytenava; enforce site-of-care review for 11 specialty drugs listed (J1757, Q5171, Q5167, J2361, J7176, J1818, Q5166, Q5173, J1577, Q5164); and review updated 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) which may result in previously covered services being denied as not medically necessary. Claims for affected medications submitted without required prior authorization will be denied. Consult Anthem's Clinical Criteria documents for complete coverage requirements before processing claims.