CommercialCoverageMedium impact
[Georgia] Clinical Criteria updates for specialty pharmacy are available
Anthem BCBS·GA·Pharmacy
We identified it
May 3, 2026
Summary
Anthem Georgia has released updated clinical criteria for specialty pharmacy services. The policy provides new guidelines that may affect coverage determinations and prior authorization requirements for specialty medications.
Action Required
Immediately: Billing team should visit the Anthem Georgia provider portal to review the updated specialty pharmacy clinical criteria. Update internal prior authorization workflows and medication coverage guidelines based on the new criteria. Communicate changes to prescribing providers to ensure compliance with new requirements.