CommercialPrior AuthMedium impact
[Georgia] New specialty pharmacy medical step therapy requirements
Anthem BCBS·GA · Oncology, Rheumatology, Endocrinology +3 more·Pharmacy
We identified it
May 30, 2026
Summary
Anthem in Georgia has implemented new step therapy requirements for specialty pharmacy medications, requiring patients to try specific lower-cost medications before accessing higher-tier specialty drugs. This policy affects prior authorization processes and may delay treatment approvals for specialty medications.
Action Required
Immediately: Billing and clinical teams must verify step therapy requirements before prescribing specialty medications for Georgia Anthem members. Update prior authorization workflows to include step therapy documentation. Inform providers that specialty drug approvals may require evidence of failed trials with lower-tier medications first.