Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 24, 2025

Prior authorization updates for medications billed under the medical benefit

Effective for dates of service on or after April 1, 2025, the following medication codes will require prior authorization.

Please note, inclusion of a National Drug Code (NDC) on the 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-0262

J9329

Tevimbra (tislelizumab-jsgr)

CC-0066

Q5135

Tyenne (tocilizumab-aazg)

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-072883-24-CPN72586

PUBLICATIONS: March 2025 Provider Newsletter