Products & Programs PharmacyMedicare AdvantageApril 8, 2024

Anthem expands specialty pharmacy precertification list

Effective for dates of service on and after August 1, 2024, the specialty Medicare Part B drugs 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

J9286

Columvi (glofitamab-gxbm)

C9162, J3490, J3590, J9999

Izervay (avacincaptad pegol)

J9333

Rystiggo (rozanolixizumab-noli)

J9334

Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-gvfc)

We look forward to working together to achieve improved outcomes.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CR-053057-24-CPN52693

PUBLICATIONS: May 2024 Provider Newsletter