Anthem clinical criteria updates for specialty pharmacy are available

Effective for dates of service on and after May 1, 2021, 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-0003 Immunoglobulins
• ING-CC-0011 Ocrevus (ocrelizumab)
• ING-CC-0041 Complement Inhibitors
• ING-CC-0048 Spinraza (nusinersen)
• ING-CC-0062 Tumor Necrosis Factor Antagonists
• ING-CC-0063 Stelara (ustekinumab)
• ING-CC-0071 Entyvio (vedolizumab)
• ING-CC-0121 Gazyva (obinutuzumab)
• ING-CC-0174 Kesimpta (ofatumumab)
• ING-CC-0183 Sogroya (somapacitan-beco)     

 

960-0221-PN-GA