Guideline Updates Prior AuthorizationHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 1, 2023

Spevigo and Xenpozyme 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 billed on medical claims will require prior authorization in accordance with the requirements of the current or new Clinical Criteria documents.

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-0221

J1747

Spevigo (spesolimab-sbzo)

CC-0220

J0218

Xenpozyme (olipudase alfa)







What if I need assistance?

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

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

VABCBS-CD-023921-23-CPN23622

PUBLICATIONS: July 2023 Provider Newsletter