Medicare AdvantageCoverageHigh impact
[Georgia] Clinical Criteria updates
Anthem BCBS·GA · Oncology, Hematology, Rheumatology +6 more·Provider Bulletin
Effective date
Jun 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem Georgia has revised clinical criteria for 45 medical drugs and added 3 new drug policies, all effective June 1, 2026. These changes affect medical necessity requirements for specialty medications including cancer treatments, immunosuppressants, and biologics administered under the medical benefit.
Action Required
By June 1, 2026: Review all 48 updated clinical criteria policies on Anthem's Clinical Criteria page to understand new medical necessity requirements for affected drugs. Update prior authorization workflows and ensure providers are aware of revised documentation requirements for specialty medications. Monitor for separate authorization requirement notices that may follow this clinical criteria update.