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Anthem Blue Cross Blue Shield of California prior authorization J3490

Anthem Blue Cross Blue Shield of California prior authorization for J3490: Unclassified drugs or biologicals [when specified as eladocagene exuparvovec-tneq (Kebilidi)] or [when specified as an ocular gene therapy agent other than voretigene neparvovec-rzyl (Luxturna)] or [when specified as elivaldogene autotemcel (Skysona)] or [when specified as etuvetidigene autotemcel (Waskyra)] or [when specified as a gene therapy for hemophilia other than Hemgenix, Beqvez, or Roctavian]

Code
J3490
Description
Unclassified drugs or biologicals [when specified as eladocagene exuparvovec-tneq (Kebilidi)] or [when specified as an ocular gene therapy agent other than voretigene neparvovec-rzyl (Luxturna)] or [when specified as elivaldogene autotemcel (Skysona)] or [when specified as etuvetidigene autotemcel (Waskyra)] or [when specified as a gene therapy for hemophilia other than Hemgenix, Beqvez, or Roctavian]
Source
California PPO Prior Authorization List, Pg 26 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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