Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after August 1, 2025, 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.

Document number	Clinical Criteria
CC‑0029	Dupixent (dupilumab)
CC‑0269	Nemluvio (nemolizumab‑ilto)
CC‑0122	Arzerra (ofatumumab)
CC‑0128	Atezolizumab (Tecentriq, Tecentriq Hybreza)
CC‑0158	Enhertu (fam‑trastuzumab deruxtecan‑nxki)
CC‑0121	Gazyva (obinutuzumab)
CC‑0061	Gonadotropin Releasing Hormone Analogs for the Treatment of Non‑Oncologic Indications
CC‑0125	Opdivo (nivolumab)
CC‑0008	Subcutaneous Hormonal Implants
CC‑0261	Winrevair (sotatercept‑csrk)

Access Clinical Criteria.

Our preapproval clinical review of non‑oncology 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.