Products & Programs PharmacyMedicaidFebruary 21, 2024

Prior authorization updates for medications billed under the medical benefit

Effective June 1, 2024, the following medication codes will require prior authorization.

Please note, inclusion of a National Drug Code (NDC) on your medical claim is necessary for claims processing.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

Clinical Criteria

HCPCS or CPT® code(s)

Drug name

CC-0062

J3490, J3590

Yuflyma (adalimumab-aaty)



What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local provider relationship management representative or call the Medi-Cal Customer Care Centers for outside L.A. County at 800-407-4627 or L.A. County at 888-285-7801.

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CABC-CD-047932-23-CPN47437

PUBLICATIONS: March 2024 Provider Newsletter