Medicare AdvantagePrior AuthMedium impact
[Virginia] Anthem expands specialty pharmacy precertification list
Anthem BCBS·VA · Hematology, Oncology, Nephrology·Pharmacy
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem Virginia is adding two specialty Medicare Part B drugs (Fesilty and Loargys) to their precertification requirement list effective September 1, 2026. These drugs will require prior authorization before administration to avoid claim denials.
Action Required
Before September 1, 2026: Billing team must update prior authorization workflow to require precertification for HCPCS codes C9399 and J3590 when billing Fesilty (fibrinogen, human‑chmt) and Loargys (pegzilarginase‑nbln) for Anthem Medicare Advantage patients in Virginia. Update billing system alerts and notify providers that noncompliance will result in claims being deemed ineligible for reimbursement.