CommercialJuly 31, 2019
Specialty pharmacy pre-service clinical review list expanded effective November 1, 2019
Effective for dates of service on and after November 1, 2019, the following non-oncology specialty pharmacy codes from current clinical criteria will be included in our pre-service clinical review process.
Please note: inclusion of NDC code on claims will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.
Pre-service clinical review of non-oncology specialty pharmacy drugs will be managed by Anthem’s medical specialty drug review team. Oncology drugs will be managed by AIM Specialty Health® (AIM), a separate company.
Medical Policy or Clinical UM Guideline |
HCPCS or CPT Codes |
NDC Codes |
Drug |
ING-CC-0050 |
J3490 J3590 |
00074-2042-01 00074-2042-02 |
Skyrizi™ |
PUBLICATIONS: August 2019 Anthem Connecticut Provider News
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