Products & Programs PharmacyCommercialFebruary 1, 2025

Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after May 1, 2025, the following Clinical Criteria will become effective:

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Aucatzyl (obecabtagene autoleucel)

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Agents for Hemophilia B

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Select Clotting Agents for Bleeding Disorders

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Agents for Hemophilia A and von Willebrand Disease

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Uplizna (inebilizumab‑cdon)

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Empaveli (pegcetacoplan)

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Complement Inhibitors

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Immunoglobulins

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Monoclonal Antibodies to Interleukin‑5

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Jemperli (dostarlimab‑gxly)

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Pemetrexed (Alimta, Pemfexy, Pemrydi)

The Medical Specialty Drug Review team at Anthem will manage the prior authorization clinical review of non-oncology specialty pharmacy drugs. Drugs used for the treatment of oncology will be managed by Carelon Medical Benefits Management, Inc.

Access the clinical criteria document information for details.

Carelon Medical Benefits Management, Inc. is an independent company providing utilization 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.

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PUBLICATIONS: February 2025 Provider Newsletter