Clinical criteria updates are available for specialty pharmacy

Effective for dates of service on and after October 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:

 

Document number	Clinical criteria
ING-CC-0200	Aduhelm (aducanumab)

 

Access the clinical criteria document information.

 

Anthem Blue Cross and Blue Shield (Anthem)’s prior authorization clinical review of non-oncology specialty pharmacy drugs will be managed by Anthem’s medical specialty drug review team. Oncology drugs 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-COMM-001552-22