Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after February 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.

 

ING-CC-0029	Dupixent (dupilumab)
ING-CC-0035	Duopa (carbidopa and levodopa enteral suspension)
ING-CC-0058	Byngezia Pen, Sandostatin, or Sandostatin LAR (Octreotide)/ Octreotide Agents
ING-CC-0142	Somatuline Depot (lanreotide)
ING-CC-0176	Beleodaq (belinostat)
ING-CC-0188	Imcivree (setmelanotide)

 

Access the Clinical Criteria document information.

 

Our prior authorization 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 AIM Specialty Health_®* (AIM). 

 

* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield.

GABCBS-CM-008722-22