[Virginia] Quarterly pharmacy formulary change notice — Cardinal Care Medicaid

By April 30, 2026: (1) Billing team must audit current patient medications against the formulary change table to identify affected patients on Cardinal Care Medicaid. (2) Update billing system to enforce new prior authorization requirements for medications listed with 'ADD PA' designation (e.g., Javadin, all Keytruda QLEX formulations, Inlexzo, Koselugo, Enbumyst, Lasix Onyu, Palsonify, Harliku, Redemplo, Voyxact, Wayrilz, Armlupeg, Gammagard Liquid/Qivigy, Kirsty insulin, Bondlido, Kygevvi, Rhapsido, Eydenzelt, Jascayd, and others). (3) Configure quantity limits in the billing system for all medications with 'ADD QL' or 'UPDATE QL' designations to prevent claims processing errors. (4) Notify providers of changes and identify patients requiring PA before May 1, 2026. (5) For patients on removed PA medications (Faslodex, Famotidine Oral Suspension, Sylvant), update systems to remove PA requirements. (6) For patients on medications with removed QL (Dhivy), remove quantity limit edits. (7) Contact Anthem Pharmacy at 800-901-0020 to request prior authorizations for patients who cannot transition to formulary alternatives. Failure to obtain PA before the effective date will result in claim denials and potential service disruptions for Medicaid beneficiaries.