Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
Notifies that, effective August 1, 2023, Anthem Blue Cross and Blue Shield is adding specific Medicare Part B specialty drugs (reported via J-codes and miscellaneous codes J3490/J3590) to its precertification review process for specialty pharmacy. Applies to Anthem commercial and Medicare plans subject to federal/state/CMS rules.
Briumvi (ublituximab) added to the specialty pharmacy precertification review list for Medicare Part B drugs effective 2023-08-01.
Leqembi (lecanemab) added to the specialty pharmacy precertification review list for Medicare Part B drugs effective 2023-08-01.
Precertification process applies to claims billed with J3490 and J3590 where appropriate for the listed Medicare Part B specialty drugs.
What is changing
Anthem is expanding its specialty pharmacy precertification requirements to include certain Medicare Part B drugs. Effective 2023-08-01, Briumvi (ublituximab) and Leqembi (lecanemab) reported via J3490, J3590, or the appropriate Medicare Part B J-code will be included in the precertification review process. Providers must obtain precertification for these affected drugs for dates of service on and after the effective date or risk claim denials.
Precertification updates & provider requirements
Precertification requirement for listed Medicare Part B specialty drugs
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