Medicare Advantage Part B Drug Updates 09012025
Blue Cross and Blue Shield of Nebraska is proud to work with our provider network to serve your patients, our members. We are updating several medical policies. Please review the changes and effective dates outlined here:
Medicare Advantage M.16 Part B Utilization Management in the Absence of NCD or LCD
Effective Date: 09/01/2025
Preauthorization Required: Yes
Policy Statement:
Adding Radiopharmaceuticals
- A9590 Azedra
- A9517 HICON
- A9513 Lutathera
- A9606 Xofigo
- A9607 Pluvicto
- A9543 Zevalin
We contract with Prime Therapeutics for Part B drugs/medications. Please submit PA requests directly to GatewayPA.
- Hours of Operation: 24 hours a day
- Call toll free: 1-800-424-1709 or fax 1-888-656-6671
- Website: https://gatewaypa.com/
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