Anthem expands specialty pharmacy precertification list

Effective for dates of service on and after December 1, 2022, the specialty Medicare Part B drug listed in the table 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
J0172	Aduhelm (aducanumab-avwa)

 

MULTI-BCBS-CR-004283-22 (MULTI-BCBS-CARE-000558-22)