CommercialPrior AuthHigh impact
[Georgia] Specialty pharmacy updates, March 2026
Anthem BCBS·GA · Oncology, Hematology, Pharmacy +2 more·Pharmacy
Effective date
Jun 1, 2026
We identified it
May 3, 2026
Summary
Effective June 1, 2026, Anthem Blue Cross Blue Shield (Georgia) is implementing new prior authorization requirements, quantity limits, and step therapy protocols for 8 specialty pharmacy medications. Billing teams must begin requesting prior authorization for these drugs on all dates of service on or after June 1, 2026, and include NDC codes on claims to expedite processing. Oncology-use prior authorizations will be managed by Carelon Medical Benefits Management rather than Anthem's standard review team.
Action Required
By May 31, 2026: Billing team must update billing software and prior authorization workflows to require prior auth submissions for all specialty pharmacy claims using the affected HCPCS codes (J3590, J9999, J3490, J2786, J0517, J9271, J9024, J9022, J2182) or C9399. Implement quantity limit edits in the billing system for Exdensur, Forzinity, Gammagard Liquid, Jubereq, Osvyrti, Redemplo, and Voyxact. Configure step therapy rules to route Keytruda Qlex and Tecentriq Hybreza to step therapy review while keeping base Keytruda and Tecentriq as preferred. For oncology-use medications (marked with *), establish separate routing to Carelon Medical Benefits Management. Train providers and clinical staff to include NDC codes on all specialty pharmacy claims. Ensure front desk and clinical teams identify patients currently receiving these medications without prior authorization and notify them of the new requirement. Failure to obtain prior authorization will result in claim denials beginning June 1, 2026.