Medicare AdvantageJune 27, 2025
Specialty pharmacy precertification list expanded
Effective for dates of service on and after November 1, 2025, the specialty Medicare Part B drug listed in the table below will be included in our precertification review process.
HCPCS codes | Medicare Part B drugs |
C9399, J9999 | Axtle (pemetrexed) |
C9399, J9999 | Bizengri (zenocutuzumab‑zbco) |
C9399, J3490 | Bynfezia pen (octreotide acetate) |
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 prevent claims from being approved.
Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross, Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BC-CR-084100-25-CPN83702
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