RSV Prevention in Children Criteria for the 2025–2026 Season
Sep 26, 2025 - • Beyfortus (nirsevimab), a long-acting monoclonal antibody product, was approved by the U.S. Food and Drug Administration (FDA) on July 17, 2023, for use in newborns and infants to protect against (medically attended) respiratory syncytial virus (RSV).1
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Continuous Glucose Monitor Policy Updates
Sep 26, 2025 - Effective October 1, 2025, Continuous Glucose Monitors (CGMs) will be covered with prior authorization (PA) for recipients (children and adults) with one of the following:
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Presumptive Eligibility for Pregnancy (PEP), Effective October 1, 2025
Sep 24, 2025 - The Alabama Legislature passed Senate Bill 102 (Act 2025-204) during the 2025 legislative session establishing Presumptive Eligibility for Pregnancy (PEP) with implementation on October 1, 2025. This will allow pregnant women early access to ambulatory prenatal care while their application for Medicaid is under review. The major provisions of the law are listed below.
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Prior Authorization Management
Sep 24, 2025 - EviCore by Evernorth currently maintains prior authorization management on two platforms, MedSolutions and CareCore National. Alabama Medicaid Radiology requests have been historically managed on the MedSolutions platform.
Effective October 1, 2025, Alabama Medicaid Radiology authorizations will be managed on the legacy CareCore National Portal. Authorizations built prior to October 1, 2025 on the MedSolutions Portal will remain there for reference.
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