Policy Updates Prior AuthorizationMedicare AdvantageMay 31, 2023

Medicare Part B Precert Expansion Briumvi Leqembi

Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

Effective for dates of service on and after August 1, 2023, 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

Briumvi (ublituximab)

J3490, J3590

Leqembi (lecanemab)

MULTI-BCBS-CR-022215-22-CPN22047

PUBLICATIONS: June 2023 Provider Newsletter