Clinical criteria and prior authorization updates for specialty pharmacy are available

Anthem Blue Cross (Anthem) prior authorization clinical review of non-oncology specialty pharmacy drugs will be managed by Anthem’s medical specialty drug review team. Oncology drugs will be managed by AIM Specialty Health® (AIM), a separate company.

 

Revised Clinical Criteria effective June 10, 2019

The following new clinical criteria were revised to expand medical necessity indications or criteria. The table attached will assist you in identifying the new document number for the clinical criteria that corresponds with the previous Clinical or Coverage Guideline.