Medicare AdvantagePrior AuthMedium impact
[Ohio] Anthem expands specialty pharmacy precertification list
Anthem BCBS·OH · Hematology, Oncology·Pharmacy
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem 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 approval before administration to avoid claim denials.
Action Required
Before September 1, 2026: Billing team must update systems to flag HCPCS codes C9399 and J3590 (Fesilty and Loargys) for mandatory prior authorization when billing Anthem Medicare Advantage plans. Update encounter forms and EMR alerts to remind providers to obtain precertification before administering these specialty drugs. Failure to obtain prior authorization will result in claims being deemed ineligible for reimbursement.