Clinical Criteria updates for specialty pharmacy

The following Clinical Criteria documents were endorsed at the March 21, 2024, Clinical Criteria meeting. Access the Clinical Criteria on our provider website.

Revised Clinical Criteria effective September 1, 2024

The following Clinical Criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary:

• CC-0003 Immunoglobulins
• CC-0062 Tumor Necrosis Factor Antagonists
• CC-0125 Opdivo (nivolumab)
• CC-0251 Ycanth (cantharidin)