California
Provider Communications
New specialty pharmacy medical step therapy requirements
Effective for dates of service on and after November 15, 2022, the following specialty pharmacy codes from current or new Clinical Criteria documents will be included in our existing specialty pharmacy medical step therapy review process. Step therapy review will apply upon prior authorization initiation or renewal in addition to the current medical necessity review of all drugs noted below.
The list of Clinical Criteria is publicly available on our provider website. Visit the [Clinical Criteria] website to search for specific Clinical Criteria.
|
Clinical Criteria |
Status |
Drug(s) |
HCPCS codes |
|
ING-CC-0107 |
Preferred |
Mvasi |
Q5107 |
|
ING-CC-0107 |
Non-preferred |
Avastin |
J9035 |
|
ING-CC-0107 |
Non-preferred |
Zirabev |
Q5118 |
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October 2022 Anthem Blue Cross Provider News - California