Products & Programs PharmacyMedicare AdvantageMarch 19, 2025

Medicare Part B preapproval expands with new drug additions

Effective for dates of service on and after July 1, 2025, the specialty Medicare Part B drugs listed below will be included in our preapproval review process.

Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these preapproval rules and must be considered first when determining coverage. Please follow the new requirements to ensure your claims are accepted.

HCPCS or CPT® codes

Medicare Part B drugs

C9399, J9999

Aucatzyl (obecabtagene autoleucel)

Q5139

Bkemv (eculizumab-aeeb)

J3590

Epysqli (eculizumab-aagh)

C9399, J3590

Hympavzi (marstacimab-hncq)

J3590

Imuldosa (ustekinumab-srlf)

J3590

Otulfi (ustekinumab-aauz)

Q9997

Pyzchiva IV (ustekinumab-ttwe)

Q9998

Selarsdi (ustekinumab-aekn)

C9399, J9999

Tecentriq Hybreza (atezolizumab and hyaluronidase-tqjs)

C9399, J9999

Vyloy (zolbetuximab-clzb)

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWI), Compcare Health Services Insurance Corporation (Compcare), and Wisconsin Collaborative Insurance Company (WCIC). BCBSWI underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CR-077630-25-CPN77426