By May 31, 2026: Billing team must update claim submission workflows to require prior authorization for all specialty pharmacy drugs listed in this policy before processing claims with service dates on or after June 1, 2026. Specifically: (1) Implement prior auth requirement triggers in billing software for HCPCS codes C9399, J3590, J9999, J3490 and CPT codes J2786, J0517, J9271, J9024, J9022, J2182; (2) Flag the following drugs for mandatory prior auth review: Armlupeg, Blenrep, Exdensur, Jubereq, Osvyrti, Poherdy, Redemplo, and Voyxact; (3) Configure quantity limit alerts in the system for Exdensur, Forzinity, Gammagard Liquid ERC, Jubereq, Osvyrti, Redemplo, and Voyxact; (4) Set step therapy rules to route Keytruda Qlex and Tecentriq Hybreza as non-preferred requiring step therapy, while Keytruda and Tecentriq remain preferred; (5) Ensure all specialty pharmacy claims include NDC codes to expedite processing; (6) Direct providers to reference Clinical Criteria documents at https://www.anthem.com/ms/pharmacyinformation/clinicalcriteria/home.html for medical necessity documentation requirements. Failure to obtain prior authorization will result in claim denials. Route oncology use prior authorizations to Carelon Medical Benefits Management, Inc. for the 4 drugs marked with asterisks (Armlupeg, Blenrep, Poherdy, Jubereq, Osvyrti).