Anthem clinical criteria updates for specialty pharmacy are available

Effective for dates of service on and after May 1, 2020, 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.

 

To access the clinical criteria document information please visit our provider website

 

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-0041   Complement Inhibitors
• ING-CC-0042 Monoclonal Antibodies to Interleukin-17
• ING-CC-0065 Agents for Hemophilia A and von Willebrand Disease
• ING-CC-0148   Agents for Hemophilia B
• ING-CC-0149    Select Clotting Agents for Bleeding Disorders
• ING-CC-0150    Kymriah (tisagenlecleucel)