Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after November 1, 2023, the following Clinical Criteria were developed and can result in previously covered services to be considered not medically necessary.

For more information on clinical criteria, 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.*