Products & Programs PharmacyMedicare AdvantageJanuary 18, 2024

RETRACTED: Expansion of specialty pharmacy precertification list

This article was published in error and retracted on February 23, 2024. Please access your state's updated version:
Colorado, Connecticut, Georgia, Indiana, Kentucy, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, Wisconsin

Effective for dates of service on and after May 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

J3490, J3590, J9999, C9399

Elrexfio (elranatamab-bcmm)

J3490, J3590

Eylea HD (aflibercept)

J3490, J3590

Pombiliti (cipaglucosidase alfa-atga)

J3490, J3590, J9999, C9399

Talvey (talquetamab-tgvs)

J3490, J3590

Tyruko (natalizumab-sztn)

J3590, C9399

Veopoz (pozelimab-bbfg)

J3490

Ycanth (cantharidin)

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-046706-23-CPN45768

PUBLICATIONS: February 2024 Provider Newsletter