Products & Programs PharmacyMedicaidMay 27, 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.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

Clinical Criteria

HCPCS or CPT® code(s)

Drug name

CC-0063

J3590

Yesintek (ustekinumab‑kfce)

CC-0275

C9302

Ziihera (zanidatamab‑hrii)

Please note: Inclusion of a National Drug Code (NDC) on your medical claim is necessary for claims processing.

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 800-450-8753.

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

Medicaid services provided by Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CPN81946, NYBCBS-CD-082728-25

PUBLICATIONS: June 2025 Provider Newsletter