MedicaidApril 1, 2021
Iron infusion medical step therapy notice
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).
PUBLICATIONS: April 2021 Anthem Blue Cross Provider News - California
To view this article online:
Visit https://providernews.anthem.com/california/articles/iron-infusion-medical-step-therapy-notice-1-7379
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