Products & Programs PharmacyCommercialFebruary 1, 2022

Anthem clinical criteria updates for specialty pharmacy are available

Effective for dates of service on and after May 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.

 

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-0001

Erythropoiesis Stimulating Agents

ING-CC-0042

Monoclonal Antibodies to Interleukin-17

ING-CC-0043

Monoclonal Antibodies to Interleukin-5

ING-CC-0049

Radicava (edaravone)

ING-CC-0050

Monoclonal Antibodies to Interleukin-23

ING-CC-0063

Stelara (ustekinumab)

ING-CC-0064

Interleukin-1 Inhibitors

ING-CC-0065

Agents for Hemophilia A and von Willebrand Disease

ING-CC-0066

Monoclonal Antibodies to Interleukin-6

ING-CC-0068

Growth Hormone

ING-CC-0071

Entyvio (vedolizumab)

ING-CC-0148

Agents for Hemophilia B

ING-CC-0149

Select Clotting Agents for Bleeding Disorders

ING-CC-0168

Tecartus (brexucabtagene autoleucel)

ING-CC-0195

Abecma (idecabtagene vicleucel)

 

1524-0222-PN-GA

PUBLICATIONS: February 2022 Anthem Provider News - Georgia