Medicare AdvantagePrior AuthMedium impact
[Georgia] Expansion of the Specialty Pharmacy precertification list
Anthem BCBS·GA · Pharmacy, Oncology·Pharmacy
Effective date
Nov 1, 2026
We identified it
Jul 23, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross Blue Shield (Medicare Advantage) in Georgia is expanding its specialty pharmacy precertification requirements to include two new Medicare Part B drugs: Decnupaz (pivekimab sunirine-pvzy) and Lumvoa (veligrotug-vvze). Billing teams must obtain precertification for these drugs before dispensing to avoid claim denials.
Action Required
By October 15, 2026: Billing team and pharmacy staff must update precertification workflows to require prior authorization for HCPCS codes J9999, C9399, C9339, and J3590 (Decnupaz and Lumvoa) when billing Anthem Blue Cross Blue Shield Medicare Advantage plans in Georgia. Update pharmacy management system, prior auth protocols, and provider communication materials to reflect new requirement. Beginning November 1, 2026, do not dispense these medications without obtaining precertification approval first. Claims submitted without required precertification will be denied and rendered ineligible for reimbursement. Coordinate with prescribing providers to ensure they understand the new precertification requirement.