Anthem clinical criteria updates for specialty pharmacy are available

Effective for dates of service on and after February 1, 2021, the following current and new 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-0029 Dupixent (dupilumab)
• ING-CC-0038  Human Parathyroid Hormone Agent
• ING-CC-0042 Monoclonal Antibodies to Interleukin-17
• ING-CC-0044 Exondys 51 (eteplirsen)
• ING-CC-0048 Spinraza (nusinersen)
• ING-CC-0050 Monoclonal Antibodies to Interleukin-23
• ING-CC-0058 Octreotide Agents (Byngezia Pen, Sandostatin, or Sandostatin LAR)
• ING-CC-0061 GnRH Analogs for the Treatment of Non-Oncologic Indications
• ING-CC-0094 Alimta (pemetrexed disodium)
• ING-CC-0119 Yervoy (ipilimumab)
• ING-CC-0124 Keytruda (pembrolizumab)
• ING-CC-0125 Opdivo (nivolumab)
• ING-CC-0139 Evenity (romosozumab-aqqg)
• ING-CC-0152 Vyondys 53 (golodirsen)

 

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