Products & Programs PharmacyMedicaidOctober 8, 2024

Prior authorization updates for medications billed under the medical benefit

Effective on or after December 1, 2024, the following medication codes will require prior authorization.

Please note that the inclusion of a National Drug Code (NDC) 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-0259

J3490, J3590

Amtagvi (lifleucel)

CC-0258

J3490, J3590

iDoseTR (travoprost Implant)

CC-0260

J7353

Nexobrid (anacaulase-bcdb)

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 844-396-2330.

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

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-065621-24-CPN64071

PUBLICATIONS: November 2024 Provider Newsletter