Medicare AdvantagePrior AuthMedium impact
[Georgia] Anthem expands specialty pharmacy precertification list
Anthem BCBS·GA · Hematology, Oncology·Pharmacy
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem Blue Cross and Blue Shield of Georgia is adding two new specialty Medicare Part B drugs (Fesilty and Loargys) to their precertification requirement list. Claims for these drugs will be denied if prior authorization is not obtained before administration.
Action Required
By September 1, 2026: Billing team must update systems to require prior authorization for HCPCS codes C9399 and J3590 when billing for Fesilty (fibrinogen, human-chmt) or Loargys (pegzilarginase-nbln) for Anthem Medicare Advantage patients in Georgia. Provider staff must obtain precertification before administering these specialty drugs. Noncompliance will result in claims being deemed ineligible for reimbursement.