Products & Programs PharmacyHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 20, 2025

Prior authorization updates for medications billed under the medical benefit

Effective for dates of service on or after July 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-0072

Q5150

Ahzantive (aflibercept‑mrbb)

CC-0072

Q5149

Enzeevu (aflibercept‑abzv)

CC-0072

C9399, J3590

Opuviz (aflibercept‑yszy)

CC-0072

Q5147

Pavblu (aflibercept‑ayyh)

CC-0072

C9399, J3590

Yesafili (aflibercept‑jbvf)

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

Contact us

Availity Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials, go to https://Availity.com and select the appropriate payer space tile from the drop‑down. Then, select Chat with Payer and complete the pre‑chat form to start your chat.

For additional support, visit the Contact Us section of our provider website for the appropriate contact.

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.

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PUBLICATIONS: June 2025 Provider Newsletter