Products & Programs PharmacyBadgerCare Plus and Medicaid SSI ProgramsApril 29, 2025

New preapproval requirements for Givlaari

Effective for dates of service on or after June 1, 2025, the following medication codes will require preapproval.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

Clinical Criteria

HCPCS or CPT® code(s)

Drug name

CC-0154

J0223

Givlaari (givosiran)

Please note: Inclusion of a National Drug Code (NDC) on your medical claim is necessary for claims processing.

Anthem Blue Cross and Blue Shield is the trade name of Compcare Health Services Insurance Corporation. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

WIBCBS-CD-081555-25-CPN77844

PUBLICATIONS: May 2025 Provider Newsletter