Specialty pharmacy updates - February 2022

Anthem specialty pharmacy updates are listed below.

Prior authorization clinical review of non-oncology use of specialty pharmacy drugs is managed by Anthem’s medical specialty drug review team. Review of specialty pharmacy drugs for oncology use is managed by AIM Specialty Health^® (AIM), a separate company.

 

Please note, inclusion of National Drug Code (NDC) code on your claim will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.

 

Prior authorization updates

Effective for dates of service on and after May 1, 2022, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our prior authorization review process.

 

Access our clinical criteria to view the complete information for these prior authorization updates.

 

Clinical Criteria	Drug	HCPCS or CPT Code(s)
*ING-CC-0204	Tivdak	J3490, J3590, J9999
ING-CC-0072	Byooviz	J3590
ING-CC-0068	Skytrofa	J3490

* Oncology use is managed by AIM.

 

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.

 

Step therapy updates

Effective for dates of service on and after May 1, 2022, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our existing specialty pharmacy medical step therapy review process. 

 

Access our clinical criteria to view the complete information for these prior authorization updates.

 

Clinical Criteria	Status	Drug	HCPCS or CPT Code(s)
ING-CC-0072	Non-Preferred	Byooviz	J3590

 

Quantity limit updates

Effective for dates of service on and after May 1, 2022, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our quantity limit review process.

 

Access our clinical criteria to view the complete information for these prior authorization updates.

 

Clinical Criteria	Drug	HCPCS or CPT Code(s)
ING-CC-0072	Byooviz	J3590

 

1526-0222-PN-CTNH