Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsSeptember 9, 2024

Prior authorization updates for medications billed under the medical benefit

Effective for dates of service on or after November 1, 2024, the following medication codes will require prior authorization.

Please note that the inclusion of a National Drug Code (NDC) 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-0003

J1599

Alyglo (immune globulin intravenous,
human-stwk)

CC-0062

J3590

Simlandi (adalimumab-ryvk)

CC-0261

C9399, J3590

Winrevair (sotatercept-csrk)

What if I need assistance?

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

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

HealthKeepers, Inc. is an independent licensee of the Blue Cross Blue Shield Association. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

VABCBS-CD-065392-24-CPN64077

PUBLICATIONS: October 2024 Provider Newsletter