Beginning June 1, 2021, Anthem Blue Cross and Blue Shield (Anthem) is implementing a designated network for select specialty pharmacy medications administered in the outpatient hospital setting (“Designated SRx Network”). This applies to all Anthem commercial members and claims priced by Anthem for commercial BlueCard Program members.  This does not apply to Medicare Advantage, Medicaid, Medicare Supplement, or the Federal Employee Program.

 

Hospitals that are not in our Designated SRx Network will be required to acquire the select specialty pharmacy medications administered in the hospital outpatient setting through CVS Specialty Pharmacy.  For dates of service on or after June 1, 2021, the prescribing provider for Anthem commercial members should continue to contact AIM Specialty Health or IngenioRx for prior authorization.   During the authorization process, the prescribing provider will be notified of the requirement to utilize CVS Specialty as the dispensing provider for the specialty pharmacy medication when administered in the outpatient hospital setting. The failure to do so will result in claim denials and the member cannot be billed for these specialty medications. Hospitals may continue to submit a claim for administration of the specialty pharmacy medications in the outpatient hospital setting, which will be reimbursed at the current contracted rates.

 

If you wish to be included in the Designated SRx Network by agreeing to the terms/conditions, please contact your Anthem facility contract manager. 

The list of specialty pharmacy medications subject to the above will be posted at anthem.com for reference and is subject to change.  All specialty pharmacy prior authorization requirements will still apply and are the responsibility of the prescribing provider.

 

This will have no impact on how members obtain non-specialty pharmacy medications at retail pharmacies or by mail-order.

 

To access the current Designated Medical Specialty Pharmacy Drug List, visit anthem.com, select Providers, select the state Colorado (top right of page), select Forms and Guides (under the Provider Resources column). Scroll down and select Pharmacy in the Category drop down.

 

 

1076-0421-PN-CO

 



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April 2021 Anthem Provider News and Important Updates -- Colorado