Products & Programs PharmacyMedicare AdvantageAugust 27, 2024

Anthem expands specialty pharmacy precertification list

Effective for dates of service on or after December 1, 2024, the specialty Medicare Part B drugs listed below will be included in our precertification review process.

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 result in denied claims.

HCPCS or CPT® codes

Medicare Part B drugs

C9399, J9999

Anktiva (nogapendekin alfa inbekicept-pmln)

J3590

Hercessi (trastuzumab-strf)

C9399, J9999

Imdelltra (tarlatamab-dlle)

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CR-064678-24-CPN64481

PUBLICATIONS: September 2024 Provider Newsletter