Effective for dates of service on and after December 1, 2022, 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.



Complement Inhibitors


Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications


Kymriah (tisagenlecleucel)



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.


* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield.


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September 2022 Anthem Provider News - Georgia