[New York] Specialty pharmacy updates, March 2026

By May 31, 2026: Billing team must update billing software and claims submission processes to enforce new prior authorization requirements for the 8 specialty pharmacy drugs listed (Armlupeg, Blenrep, Exdensur, Jubereq, Osvyrti, Poherdy, Redemplo, Voyxact) when billed with codes C9399, J3590, J9999, or J3490. Configure system to route oncology prior auth requests to Carelon Medical Benefits Management and non-oncology requests to Anthem's medical specialty drug review team. Implement quantity limit edits for 8 drugs (Exdensur, Forzinity, Gammagard Liquid ERC, Jubereq, Osvyrti, Qivigy, Redemplo, Voyxact) and step therapy edits requiring Keytruda and Tecentriq as preferred first-line before Keytruda Qlex and Tecentriq Hybreza. Train billing staff to include NDC codes on claims to expedite processing for NOC-coded drugs. Notify providers that prior authorization will be required for continued patient use of these medications effective June 1, 2026. Failure to obtain prior authorization will result in claim denials and coverage gaps for patients currently receiving these drugs.