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Blue Cross and Blue Shield of North Carolina Expands Specialty Pharmacy Precertification List November 01, 2021 Pharmacy Blue Medicare

Please note, this communication applies to Healthy Blue + Medicare (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.

Effective on and after January 1, 2022, the specialty Medicare Part B drugs listed in the table below will be included in our precertification review process.

Federal and state law, as well as state contract language and Centers for Medicare and Medicaid Services guidelines — including definitions and specific contract provisions/exclusions — take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

HCPCS OR CPT® CODEMEDICARE PART B DRUGS
J9353J9353 Margenza
J3490, J3590, C9076Breyanzi
J3490, J3590, C9075Amondys 45
J3490, J3590, C9399Nulibry
Q5123Riabni
C9399, J3490, J3590, J9999Abecma
J3490, J9999, C9080Pepaxto
J3490, C9078Cosela
J3490, C9079Evkeeza
J3490, J3590, J9999Zynlonta
J3490, J3590, J9999Jemperli
J3490, J3590, C9399Empaveli
J9999Rybrevant

For more information, visit Healthy Blue + Medicare