Medicare AdvantagePrior AuthMedium impact
[California] Anthem expands specialty pharmacy precertification list
Anthem BCBS·CA · Hematology, Oncology, Nephrology·Pharmacy
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem is adding two new specialty Medicare Part B drugs (Fesilty and Loargys) to their precertification requirement list effective September 1, 2026. Claims for these drugs will be denied without prior authorization approval.
Action Required
By September 1, 2026: Billing team must update system to require prior authorization for HCPCS codes C9399 and J3590 when billing for Fesilty (fibrinogen, human-chmt) and Loargys (pegzilarginase-nbln) for Anthem Medicare Advantage patients. Update encounter forms and provider reminders. Claims without precertification will be denied.