Specialty Pharmacy Precertification List Expansion Effective September 2022
Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.
Effective for dates of service on and after September 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 & Medicaid Services guidelines, including definitions and specific contract provisions and 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® codes | Medicare Part B drugs |
| C9399, J3490, J3590, J9999 | Kimmtrak (tebentafusp-tebn) |
| C9399, J3490, J3590, J9999 | Enjaymo (sutimlimab-jome) |
| C9399, J3590 | Tezspire (tezepelumab-ekko) |
| J3490, J3590 | Vabysmo (faricimab-svoa) |
For more information, visit Healthy Blue + Medicare.
BNCCARE-0684-22 April 2022