Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after March 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.

 

Document number	Clinical Criteria
ING-CC-0018	Agents for Pompe Disease

 

Access Clinical Criteria information here.

 

Anthem Blue Cross and Blue Shield’s (Anthem’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 AIM Specialty Health_®, a separate company.

* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield.
GABCBS-CM-011279-22