Designated specialty pharmacy network updates (MAC)

Material adverse change (MAC)

 

As we have previously communicated, Anthem’s Designated Specialty Pharmacy Network requires providers who are not part of the Designated Specialty Pharmacy Network to acquire certain select specialty pharmacy medications administered in the hospital outpatient setting through CVS Specialty Pharmacy.

 

This update is to advise of the following changes:

 

Effective for dates of service on and after July 1, 2022, the following specialty pharmacy medications will be added to the Designated Medical Specialty Pharmacy drug list. Accordingly, hospitals that are not in the Designated Specialty Pharmacy Network will be required to acquire these specialty medications administered in the hospital outpatient setting from CVS Specialty Pharmacy.

 

HCPCS code	Description	Brand Name
J9272	Dostarlimab-gxly	Jemperli
J9316	Pertuzumab/Trastuzumab/Hyaluronidase-zzxf	Phesgo

 

To access the current Designated Medical Specialty Pharmacy drug list, please visit anthem.com/provider > Forms and Guides (under the Provider Resources column) > select state, scroll down and select Pharmacy in the Category drop down. Note that Anthem may update the Designated Medical Specialty Pharmacy drug list periodically, so check the list regularly.

 

If you have questions or would like to discuss the terms and conditions to be included as a Designated Specialty Pharmacy Network provider, please contact your Anthem Contract Manager. 

 

Thank you for your continued participation in the Anthem networks and the services you provide to our members.

 

1482-0422-PN-GA