Products & Programs PharmacyMedicaidAugust 31, 2023

Notice of Material Amendment to Healthcare Contract: Prior authorization updates for medications billed under the medical benefit

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Effective October 1, 2023, the following medication codes will require prior authorization.

Please note, inclusion of a national drug code on your medical claim is necessary for claims processing.

Visit the Clinical Criteria website to search for the following Clinical Criteria:

Clinical Criteria

HCPCS or CPT® code(s)

Drug name

CC-0072

Q5129

Vegzelma (bevacizumab-adcd)

CC-0107

Q5129

Vegzelma (bevacizumab-adcd)

 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 800-450-8753.

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

NYBCBS-CD-026969-23-CPN25795

PUBLICATIONS: October 2023 Provider Newsletter