Medicare AdvantageApril 16, 2025
Specialty pharmacy preapproval list update
Effective for dates of service on and after August 1, 2025, the specialty Medicare Part B drug listed in the table below will be included in our preapproval review process.
Federal and state law, state contract language, and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over preapproval rules and must be considered first when determining coverage. Claims that do not comply with these new requirements may not be approved.
HCPCS code | Medicare Part B drug |
Q5136 | Jubbonti; Wyost (denosumab‑bbdz) |
Blue Medicare Advantage is the trade name of Group Retiree Health Solutions, Inc., an independent licensee of the Blue Cross Blue Shield Association.
PAIBC-CR-077557-25-CPN77132
To view this article online:
Or scan this QR code with your phone