Products & Programs PharmacyMedicare AdvantageApril 8, 2024

Anthem expands specialty pharmacy precertification list

Effective for dates of service on and after August 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

J9286

Columvi (glofitamab-gxbm)

C9162, J3490, J3590, J9999

Izervay (avacincaptad pegol)

J9333

Rystiggo (rozanolixizumab-noli)

J9334

Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-gvfc)

We look forward to working together to achieve improved outcomes.

Medicare services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC., or Anthem Blue Cross and Blue Shield Retiree Solutions, trade name of Anthem Insurance Companies, Inc.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CR-053057-24-CPN52693

PUBLICATIONS: May 2024 Provider Newsletter