← Back to list
[Ohio] Specialty pharmacy precertification list expands
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 14, 2026
Summary
Anthem Blue Cross and Blue Shield (Ohio) is expanding its specialty pharmacy precertification requirements for Medicare Advantage members. Effective February 1, 2027, three new Part B drugs (golimumab, bevacizumab, and isatuximab) will require prior authorization. Additionally, effective January 1, 2027, step therapy requirements are being added to eight existing Part B medications (denosumab, bendamustine, pemetrexed, and hyaluronate formulations). Noncompliance with precertification requirements may result in claim denial.
Get alerts when payers change rules like this one
We check Anthem BCBS and other payers every day and email you when a change matches your specialty and state.
Get Anthem BCBS alertsPolicy Monitoring is free. No card required.
What to do
by Jan 1, 2027 · 6 steps
01Billing and precertification teams must implement step therapy precertification review for denosumab (Bildyos, Enoby, Bilprevda, Xtrenbo), bendamustine (Treanda, Bendeka, Belrapzo, Vivimusta), pemetrexed (Alimta and all generic/brand formulations), and hyaluronate (Hymovis One) when initiating prior authorization requests for Anthem Medicare Advantage members in Ohio.
02Step therapy will not apply to members already receiving these medications.
03By February 1, 2027: Billing and precertification teams must add prior authorization requirements for three additional Part B drugs—golimumab-sldi (Immgolis Intri), bevacizumab-vikg (Lytenava), and isatuximab-irfc (Sarclisa Escena)—using HCPCS codes C9399, J3590, and C9399/J9999 respectively for Anthem Medicare Advantage members in Ohio.
04Update billing system workflows to require precertification submission before claims processing.
05Verify access to Anthem's Clinical Criteria Guidelines on the provider portal to support step therapy determinations.
06Noncompliance with these requirements may result in ineligibility for reimbursement.
Codes mentioned
C9399J3590J9999J9033J9034J9036J9056J9305J9314J9322J9323J9294J9296J9297J9304
Original notice
[Ohio] Specialty pharmacy precertification list expands
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[California] Specialty pharmacy precertification list expandsMediumNo effective date · Pharmacy[New York] Specialty pharmacy precertification list expandsHighEffective Jan 1, 2027 · Pharmacy[Virginia] Specialty pharmacy precertification list expandsHighEffective Jan 1, 2027 · Pharmacy[Georgia] Specialty pharmacy precertification list expandsMediumNo effective date · PharmacyBrowse every Anthem BCBS change in the policy list