Effective for dates of service on and after November 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-0107 Bevacizumab for Non-Ophthalmologic Indications
  • ING-CC-0124 Keytruda (pembrolizumab)
  • ING-CC-0128 Tecentriq (atezolizumab)
  • ING-CC-0160 Vyepti (eptinezumab)
  • ING-CC-0198 Relizorb (immobilized lipase) cartridge



Featured In:
August 2021 Anthem Provider News - Georgia