Clinical Criteria updates for specialty pharmacy

Effective for dates of service on and after June 1, 2023, the following Clinical Criteria were developed 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.

Prior authorization clinical review of non-oncology specialty pharmacy drugs will be managed by the Medical Specialty Drug Review team for Anthem Blue Cross and Blue Shield. Drugs used for the treatment of oncology will be managed by Carelon Medical Benefits Management, Inc.*