Products & Programs PharmacyHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMay 20, 2025

New preapproval requirements for Givlaari

Effective for dates of service on or after August 1, 2025, the following medication codes will require preapproval.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

Clinical Criteria

HCPCS or CPT® code(s)

Drug name

CC-0154

J0223

Givlaari (givosiran)

Please note: Inclusion of a National Drug Code (NDC) on your medical claim is necessary for claims processing.

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

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-078377-25-CPN77844

PUBLICATIONS: June 2025 Provider Newsletter