State & FederalMedicaidJanuary 1, 2020

Medical drug benefit Clinical Criteria updates

Category: Medi-Cal Managed Care


This communication applies to the Medicare Advantage and MMP programs for Anthem Blue Cross (Anthem).

 

On August 16, 2019, the Pharmacy and Therapeutics (P&T) Committee approved Clinical Criteria applicable to the medical drug benefit for Anthem. These policies were developed, revised or reviewed to support clinical coding edits.

 

The Clinical Criteria is publicly available on the provider website, and the effective dates will be reflected in the Clinical Criteria Web Posting August 2019. Visit Clinical Criteria to search for specific policies.

 

For questions or additional information, use this email.