Medicare AdvantagePrior AuthMedium impact
[New York] Anthem expands specialty pharmacy precertification list
Anthem BCBS·NY · Hematology, Oncology·Pharmacy
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem is adding two new specialty Medicare Part B drugs to their precertification requirements: Fesilty (fibrinogen, human‑chmt) and Loargys (pegzilarginase‑nbln), both billed under codes C9399 and J3590. Claims for these drugs will require prior authorization starting September 1, 2026, and may be denied without proper precertification.
Action Required
Before September 1, 2026: Billing team must update prior authorization workflows to require precertification for Fesilty and Loargys when billed under HCPCS codes C9399 and J3590 for Anthem Medicare Advantage patients. Update billing system rules and staff training materials. Failure to obtain precertification may result in claims being deemed ineligible for reimbursement.