Medicare AdvantagePrior AuthMedium impact
[California] Expansion of Specialty Pharmacy precertification list
Anthem BCBS·CA · Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Oct 1, 2026
We identified it
Jun 25, 2026
Summary
Effective October 1, 2026, Anthem Blue Cross Medicare Advantage in California is expanding its specialty pharmacy precertification requirements to include two new Part B drugs: Filkri (filgrastim-laha) and Ponlimsi (denosumab-adet). Both medications will now require prior authorization and step therapy review, with step therapy exemptions for members already receiving these drugs.
Action Required
By September 15, 2026: Billing team must update the prior authorization workflow in the billing system to require precertification for HCPCS codes C9399 and J3590 (Filkri and Ponlimsi) for all Anthem Blue Cross Medicare Advantage members in California. Configure step therapy logic to bypass step therapy requirements for members with active therapy. Update provider encounter forms and clinical staff communication to alert prescribers of the new authorization requirements. Failure to obtain prior authorization before dispensing will result in claim denials. Contact Anthem through Availity Chat (https://Availity.com) with any questions about clinical criteria or member eligibility.