Products & Programs PharmacyMedicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

Effective for dates of service on and after July 1, 2025, the specialty Medicare Part B drugs listed below will be included in our preapproval 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 preapproval rules and must be considered first when determining coverage. Please follow the new requirements to ensure your claims are accepted.

HCPCS or CPT® codes

Medicare Part B drugs

C9399, J9999

Aucatzyl (obecabtagene autoleucel)

Q5139

Bkemv (eculizumab-aeeb)

J3590

Epysqli (eculizumab-aagh)

C9399, J3590

Hympavzi (marstacimab-hncq)

J3590

Imuldosa (ustekinumab-srlf)

J3590

Otulfi (ustekinumab-aauz)

Q9997

Pyzchiva IV (ustekinumab-ttwe)

Q9998

Selarsdi (ustekinumab-aekn)

C9399, J9999

Tecentriq Hybreza (atezolizumab and hyaluronidase-tqjs)

C9399, J9999

Vyloy (zolbetuximab-clzb)

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-077630-25-CPN77426