Products & Programs PharmacyMedicaidMay 20, 2025

Prior authorization updates for medications billed under the medical benefit

Effective for dates of service on or after September 1, 2025, the following medication codes will require prior authorization.

Please note that including 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.

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

Clinical Criteria

HCPCS or CPT® code(s)

Drug name

CC-0262

J9329

Tevimbra (tislelizumab-jsgr)

CC-0066

Q5135

Tyenne (tocilizumab-aazg)

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 Provider Services at at 800‑407‑4627 (TTY 711) outside L.A. County or 888‑285‑7801 (TTY 711) inside L.A. County.

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-079427-25-CPN78050

PUBLICATIONS: June 2025 Provider Newsletter