Effective for dates of service on and after August 1, 2021, the following current clinical criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary.


Access the clinical criteria document information.


Anthem’s prior authorization clinical review of non-oncology specialty pharmacy drugs will be managed by Anthem’s medical specialty drug review team. Drugs used for the treatment of oncology will be managed by AIM Specialty Health® (AIM), a separate company


  • ING-CC-0033 Xolair (omalizumab)
  • ING-CC-0043 Monoclonal antibodies to interleukin-5
  • ING-CC-0119 Yervoy (ipilimumab)
  • ING-CC-0125 Opdivo (nivolumab)
  • ING-CC-0157 Padcev (enfortumab vedotin)
  • ING-CC-0189 Amondys 45 (casimersen)
  • ING-CC-0190 Nulibry (fosdenopterin)



Featured In:
May 2021 Anthem Provider News - Georgia