Anthem clinical criteria updates for specialty pharmacy are available

Effective for dates of service on and after June 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-0062	Tumor Necrosis Factor Antagonists
ING-CC-0078	Orencia (abatacept)
ING-CC-0207	Vyvgart (efgartigimod alfa-fcab)
ING-CC-0208	Adbry (tralokinumab)
ING-CC-0209	Leqvio (inclisiran)

 

779-0222-PN-GA