Products & Programs PharmacyCommercialDecember 1, 2024

Anthem’s Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after March 1, 2025, the following Clinical Criteria were developed and might result in services that were previously covered now being found to be not medically necessary.

CC-0012

Brineura (cerliponase alfa)

CC-0029

Dupixent (dupilumab)

Access the clinical criteria document information (carelonrx.com).

Our prior authorization clinical review of nononcology specialty pharmacy drugs will be managed by our medical specialty drug review team. Drugs used for the treatment of oncology will be managed by Carelon Medical Benefits Management, Inc., a separate company.

Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.
CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of the health plan.

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

GABCBS-CM-071895-24

PUBLICATIONS: December 2024 Provider Newsletter