Policy Updates Prior AuthorizationMedicaidNovember 9, 2023

Prior authorization update - Idacio

Prior authorization updates for medications billed under the medical benefit

Effective on January 1, 2024, the following medication codes billed on medical claims from current or new Clinical Criteria documents will require prior authorization.

Inclusion of a national drug code 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-0062

J3490, Q5131

Idacio (adalimumab-aacf)

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local provider relationship management representative or call Provider Services at 800-454-3730.

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.

Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

KYBCBS-CD-040832-23-CPN40471

PUBLICATIONS: December 2023 Provider Newsletter