Anthem clinical criteria updates for specialty pharmacy are available

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.

 

ING-CC-0041	Complement Inhibitors
ING-CC-0061	Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications
ING-CC-0150	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.

GABCBS-CM-004230-22