REMINDER: Changes to the process for Medical Non-Oncology Specialty Drug reviews effective June 15, 2019

In the June Provider News  we announced the transition of the medical non-oncology specialty drug review process from AIM Specialty Health® (AIM) to Anthem Blue Cross and Blue Shield (Anthem)’s medical specialty drug review team, effective June 15, 2019. Here’s a reminder of the changes.

 

What has changed?

 

• Beginning June 15, 2019 all new or reauthorization specialty drug review requests, that were previously performed by AIM, providers need to submit a new prior authorization request by contacting Anthem’s medical specialty drug review team:
  • by phone at 833-293-0659
  • by fax at 888-223-0550
• All inquiries about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration are being managed by Anthem’s medical specialty drug review team.

 

What has not changed? 

 

• AIM continues to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
• Specialty drug review processes not previously done by AIM remain unchanged.
• Clinical criteria for medical non-oncology specialty drugs continues to reside on the clinical criteria page on anthem.com.
• Post service clinical coverage reviews and grievance and appeals process and teams have not changed.

 

Here is a summary of the medical specialty drug changes beginning June 15, 2019:

Action	Contact
Submit a new prior authorization request for a medical specialty drug review   Submit a reauthorization request for a medical specialty drug review previously performed by AIM	Call Anthem at 1-833-293-0659 or Fax Anthem at 1-888-223-0550
Inquire about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration	Call Anthem at 1-833-293-0659