Material adverse change

 

Specialty pharmacy updates for Anthem Blue Cross and Blue Shield (Anthem) are listed below.

 

Prior authorization clinical review of non-oncology use of specialty pharmacy drugs is managed by Anthem’s medical specialty drug review team. Review of specialty pharmacy drugs for oncology use is managed by AIM Specialty Health® (AIM), a separate company.

 

Inclusion of National Drug Code (NDC) code on your claim will help expedite claim processing of drugs billed with a Not Otherwise Classified (NOC) code.

 

Step therapy updates

 

Effective for dates of service on and after January 1, 2023, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our existing specialty pharmacy medical step therapy review process. 

 

Please note that infliximab agents are subject to step therapy today and this is to notify of the changes in the preferred and non-preferred products. Inflectra will become non-preferred and Avsola will become preferred as of January 1, 2023.

 

Access our Clinical Criteria to view the complete information for these step therapy updates.

 

Clinical Criteria

 Status

Drug

HCPCS or CPT Code(s)

ING-CC-0062

Preferred

Avsola

Q5121

ING-CC-0062

Preferred

Infliximab Unbranded

J1745

ING-CC-0062

Preferred

Remicade

J1745

ING-CC-0062

Non-preferred

Inflectra

Q5103

ING-CC-0062

Non-preferred

Renflexis

Q5104

 

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

 

GABCBS-CM-007034-22-CPN6800



Featured In:
October 2022 Anthem Provider News - Georgia