Specialty pharmacy precertification list expansion — key updates

Effective for dates of service on and after October 1, 2025, the specialty Medicare Part B drug listed in the table below will be included in our precertification review process.

Federal and state laws, along with state contract language and CMS guidelines — including definitions and specific contract provisions or exclusions — take priority over these precertification rules and must be considered first when determining coverage.

Note: Ensuring compliance with the new requirements will help facilitate claim approval.