Products & Programs PharmacySimply Healthcare Plans, Inc. - Medicaid Managed CareSimply Healthcare Plans, Inc. - Florida Healthy KidsClear Health Alliance - Medicaid Managed CareFebruary 24, 2025

Preapproval updates for medications billed under the medical benefit

Effective for dates of service on or after April 1, 2025, the following medication codes will require preapproval.

Please note that the inclusion of a National Drug Code (NDC) on your medical claim is necessary for claims processing.

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

Clinical Criteria

HCPCS or CPT® code(s)

Drug name

CC-0259

J3490, J3590

Amtagvi (lifleucel)

CC-0260

J7353

Nexobrid (anacaulase‑bcdb)

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative at 844-405-4296.

Note: Preapproval requests for certain medications may require additional documentation to determine medical necessity.

Simply Healthcare Plans, Inc. is a Managed Care Plan with a Florida Medicaid contract.
Simply Healthcare Plans, Inc. is a Managed Care Plan with a Florida Healthy Kids contract.
Simply Healthcare Plans, Inc. dba Clear Health Alliance is a Managed Care Plan with a Florida Medicaid contract.

FLSMPLY-CD-072783-24-CPN72577

PUBLICATIONS: March 2025 Provider Newsletter