California
Provider Communications
Clinical criteria updates
Summary:
On August 21, 2020, November 20, 2020, and June 24, 2021, the Pharmacy and Therapeutics (P&T) Committee approved the following Clinical Criteria applicable to the medical drug benefit for Anthem Blue Cross. These policies were developed, revised, or reviewed to support clinical coding edits.
Visit Clinical Criteria to search for specific policies. For questions or additional information, use this email.
Please see the explanation/definition for each category of Clinical Criteria below:
- New: newly published criteria
- Revised: addition or removal of medical necessity requirements, new document number
- Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive
Please share this notice with other members of your practice and office staff.
Please note: The Clinical Criteria listed below applies only to the medical drug benefits contained within the member’s medical policy. This does not apply to pharmacy services.
|
Effective date |
Document number |
Clinical Criteria title |
New or revised |
|
December 31, 2021 |
*ING-CC-0201 |
Rybrevant (amivantamab-vmjm) |
New |
|
December 31, 2021 |
*ING-CC-0042 |
Monoclonal Antibodies to Interleukin-17 |
Revised |
|
December 31, 2021 |
*ING-CC-0050 |
Monoclonal Antibodies to Interleukin-23 |
Revised |
|
December 31, 2021 |
ING-CC-0125 |
Opdivo (nivolumab) |
Revised |
|
December 31, 2021 |
ING-CC-0124 |
Keytruda (pembrolizumab) |
Revised |
|
December 31, 2021 |
*ING-CC-0102 |
GnRH Analogs for Oncologic Indications |
Revised |
|
December 31, 2021 |
ING-CC-0076 |
Nulojix (belatacept) |
Revised |
|
December 31, 2021 |
*ING-CC-0077 |
Palynziq (pegvaliase-pqpz) |
Revised |
|
December 31, 2021 |
ING-CC-0067 |
Prostacyclin Infusion and Inhalation Therapy |
Revised |
|
December 31, 2021 |
ING-CC-0194 |
Cabenuva (cabotegravir extended-release; rilpivirine extended-release) Injection |
Revised |
|
December 31, 2021 |
*ING-CC-0174 |
Kesimpta (ofatumumab) |
Revised |
|
December 31, 2021 |
*ING-CC-0182 |
Agents for Iron Deficiency Anemia |
Revised |
Featured In:
November 2021 Anthem Blue Cross Provider News - California