Products & Programs PharmacyMedicaidApril 29, 2025

New preapproval rules for medications

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

Including a national drug code (NDC) on your medical claim is necessary for claims processing.

For more information, click on the Clinical Criteria links in the table below or visit Clinical Criteria and enter the code in the search window.

Clinical Criteria

HCPCS or CPT® code(s)

Drug name

CC-0267

C9399, J3590

Ebglyss (lebrikizumab-lbkz)

CC-0268

J9161

Lymphir (denileukin diftitox-cxdl)

CC-0270

J9038

Niktimvo (axatilmab-csfr)

CC-0011

J2351

Ocrevus Zunovo (ocrelizumab/hyaluronidase-ocsq)

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

What if I need assistance?

If you have any questions, contact your local provider relationship management representative or Provider Services at 844‑396‑2330.

Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NVBCBS-CD-079709-25-CPN78407

PUBLICATIONS: May 2025 Provider Newsletter