Products & Programs PharmacyMedicaidJune 10, 2025

Prior authorization updates for medications billed under the medical benefit

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

Please note that the 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-0259

C9399, J9999

Amtagvi (lifleucel)

CC-0258

J7355

iDoseTR (travoprost Implant)

CC-0260

J7353

Nexobrid (anacaulase‑bcdb)

What if I need assistance?

If you have questions or need assistance with any other item, contact your local Provider Relations representative or contact our Medi‑Cal Customer Care Center at 800‑407‑4627 (TTY 711) outside L.A. County or 888‑285‑7801 (TTY 711) inside L.A. County.

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-080277-25