Medicare AdvantagePrior AuthMedium impact
[California] Expansion of the Specialty Pharmacy precertification list
Anthem BCBS·CA · Oncology, Pharmacy·Pharmacy
Effective date
Nov 1, 2026
We identified it
Jul 23, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross Medicare Advantage in California 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 implement prior authorization workflows for these drugs using the specified HCPCS and CPT codes to avoid claim denials.
Action Required
By October 1, 2026: Billing team must update precertification protocols in the billing system to require prior authorization for HCPCS codes C9399, J9999 (Decnupaz) and C9339, J3590 (Lumvoa) for all Anthem Blue Cross Medicare Advantage patients in California. Update encounter templates and provider education materials to notify clinicians of the new precertification requirement. Clinical staff must obtain prior authorization before dispensing these specialty drugs effective November 1, 2026. Failure to obtain precertification will render claims ineligible for reimbursement.