Dec 1, 2020 • Products & Programs / Pharmacy

Georgia Anthem Blue Cross and Blue Shield (Anthem) is developing a designated network to provide specialty medications in support of our members’ benefits in 2021. Providers who are designated participants in this specialty pharmacy network will supply certain specialty drugs covered under the member medical benefit plan. Our designated network of pharmacy providers will fulfill and distribute specialty pharmaceuticals more efficiently by alleviating the “buy and bill” process that sometimes applies to specialty medications.  Please note that this process will have no impact on how members obtain non-specialty pharmacy drugs at retail pharmacies or by mail-order

 

Beginning March 1, 2021, hospitals will be required to obtain select specialty pharmacy medications, administered in the outpatient setting, through the providers participating in the designated specialty network, which includes CVS Specialty. Failure to obtain specialty drugs through the designated specialty pharmacy network may result in claim denials.

 

The specialty drugs required to be obtained from providers participating in the designated specialty pharmacy network will be posted at anthem.com/providers. This change will not affect the authorization requirements and utilization management oversight currently in place for these specialty drugs.

 

Any contracted Hospitals interested in becoming a participating provider in Anthem’s designated specialty pharmacy network, must contact the Anthem provider contracting team. 

 

 

858-1220-PN-GA


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December 2020 Anthem Provider News - Georgia