Effective for dates of service on and after June 1, 2020, the following medical injectable drugs and corresponding codes will be included in our medical step therapy precertification review process. Step therapy review will apply upon precertification initiation or renewal in addition to other current medical necessity review of all drugs noted below. Haegarda® and Takhzyro™ will be the preferred prophylactic agents over Cinryze®. 

 

The Clinical Criteria below will be updated to include the required trial of the preferred drug:

 

Clinical Criteria

Preferred drug

Nonpreferred drug

ING-CC-0034

Haegarda (J0599)

Cinryze (J0598)

ING-CC-0034

Takhzyro (J3490, J3590, C9399)

Cinryze (J0598)


Clinical Criteria
is made publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.

 

 For questions or additional information, use this email.



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April 2020 Anthem Blue Cross Provider News - California