Medicare AdvantagePrior AuthMedium impact
[New York] Expansion of the Specialty Pharmacy precertification list
Anthem BCBS·NY · Oncology, Pharmacy·Pharmacy
Effective date
Nov 1, 2026
We identified it
Jul 23, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield Medicare Advantage plans in New York are adding two specialty pharmacy medications (Decnupaz and Lumvoa) to their precertification review process. Billing teams must obtain prior authorization for these Medicare Part B drugs before claim submission to avoid denial.
Action Required
By October 15, 2026: Billing team must implement prior authorization requirements in billing software for HCPCS codes J9999, C9399, C9339, and J3590 when billed to Anthem Blue Cross Medicare Advantage plans in New York. Update claim submission workflows to flag these codes and require precertification approval before transmission. Notify providers and pharmacy staff that Decnupaz (pivekimab sunirine-pvzy) and Lumvoa (veligrotug-vvze) require prior auth authorization. Non-compliance will render claims ineligible for reimbursement.