Anthem Blue Cross expands specialty pharmacy precertification list

Effective for dates of service on and after April 1, 2022, the specialty Medicare Part B drugs listed in the table below will be included in our precertification review process.

Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

HCPCS or CPT® code	Medicare Part B drugs
J3490, J3590	Saphnelo
J3490, J3590	Ryplazim
J3590	Rylaze

ACADPEC-774-21