Medicare AdvantageJune 17, 2025
Specialty pharmacy precertification list expansion — key updates
Effective for dates of service on and after October 1, 2025, the specialty Medicare Part B drug listed in the table below will be included in our precertification review process.
Federal and state laws, along with state contract language and CMS guidelines — including definitions and specific contract provisions or exclusions — take priority over these precertification rules and must be considered first when determining coverage.
Note: Ensuring compliance with the new requirements will help facilitate claim approval.
HCPCS or CPT® codes | Medicare Part B drugs |
J3590 | Alhemo (concizumab‑mtci) |
C9399, J9999 | Datroway (datopotamab deruxtecan‑dlnk) |
C9399, J9999 | Grafapex (treosulfan) |
C9399, J9999 | Opdivo Qvantig (nivolumab hyaluronidase‑nvhy) |
C9399, J3590 | Steqeyma (ustekinumab‑stba) |
C9399, J9999 | Unloxcyt (cosibelimab‑ipdl) |
J3590 | Yesintek (ustekinumab‑kfce) |
C9302 | Ziihera (zanidatamab‑hrii) |
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CR-082709-25-CPN81629
PUBLICATIONS: July 2025 Provider Newsletter
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