Guideline Updates Prior AuthorizationHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 31, 2023

Cimerli Medical Prior Authorization Update

Prior authorization updates for medications billed under the medical benefit

Please note, this communication applies to Anthem HealthKeepers Plus Medicaid products offered by HealthKeepers, Inc.

Effective for dates of service on and after July 1, 2023, the following medication codes from current or new Clinical Criteria documents billed on medical claims 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 specific Clinical Criteria listed below.

Clinical Criteria

HCPCS or CPT® code(s)

Drug name

CC-0072

Q5128

Cimerli (ranibizumab-cqrn)





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

What if I need assistance?

If you have any questions about this communication, call Anthem HealthKeepers Plus Provider Services at 800-901-0020.

VABCBS-CD-020184-23-CPN19824

PUBLICATIONS: July 2023 Provider Newsletter