Products & Programs PharmacyCommercialDecember 1, 2023

Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after March 1, 2024, the following Clinical Criteria were developed. These updates may result in services that were previously covered to no longer be medically necessary.

CC-0018

Pompe Disease

CC-0233

Rebyota (fecal microbiota, live – jslm)

CC-0250

Veopoz (pozelimab-bbfg)

Access the Clinical Criteria document information here:

anthem.com/ms/pharmacyinformation/clinicalcriteria.html

Anthem Blue Cross and Blue Shield’s prior authorization clinical review of non-oncology specialty pharmacy drugs will be managed by Anthem’s medical specialty drug review team. Drugs used for the treatment of oncology will be managed by Carelon Medical Benefits Management, Inc.

We are committed to finding solutions that help our care provider partners offer quality services to our members.

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.

GABCBS-CM-043826-23

PUBLICATIONS: December 2023 Provider Newsletter