Effective for dates of service on and after June 1, 2021, Anthem Blue Cross will include the specialty pharmacy drugs and corresponding codes from current Clinical Criteria noted below in our medical step therapy precertification review process. Step therapy review applies upon precertification initiation or renewal, in addition to the current medical necessity review.

Clinical Criteria

Status

Drug(s)

HCPCS codes

ING-CC-0182

Preferred

Infed

J1750

ING-CC-0182

Preferred

Venofer

J1756

ING-CC-0182

Preferred

Ferrlecit

J2916

ING-CC-0182

Nonpreferred

Injectafer

J1439

ING-CC-0182

Nonpreferred

Feraheme

Q0138 (non-ESRD use)

ING-CC-0182

Nonpreferred

Monoferric

J1437



The Clinical Criteria is publicly available on our provider website. Visit https://www.anthem.com/ms/pharmacyinformation/Agents-for-Iron-Deficiency-Anemia.pdf for the specific Clinical Criteria.

 

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 or call one of our Medi-Cal Customer Care Centers at 1-800-407-4627 (outside L.A. County) or 1-888-285-7801 (inside L.A. County).



Featured In:
April 2021 Anthem Blue Cross Provider News - California