Products & Programs PharmacyMedicaidMay 15, 2025

Prior authorization updates for medications billed under the medical benefit

Effective for dates of service on or after July 1, 2025, the following medication codes will require prior authorization.

Please note, inclusion of a national drug code (NDC) on the 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-0027

Q5136

Jubbonti; Wyost (denosumab-bbdz)

CC-0269

C9399, J3590

Nemluvio (nemolizumab-ilto)

CC-0002

C9173, Q5148

Nypozi (filgrastim‑txid)

CC-0266

J0870

Rytelo (imetelstat)

CC-0271

Q2057

Tecelra (afamitresgene autoleucel)

CC-0003

J3590

Yimmugo (immuneglobulin intravenous, human‑dira)

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

Contact us

Availity Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials, go to https://Availity.com and select the appropriate payer space tile from the drop‑down. Then, select Chat with Payer and complete the pre‑chat form to start your chat.

For additional support, visit the Contact Us section of our provider website for the appropriate contact.

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-079918-25-CPN78812

PUBLICATIONS: June 2025 Provider Newsletter