New specialty pharmacy medical step therapy requirements

Starting July 1, 2025, the following Part B medications from the current Clinical Criteria Guidelines will be included in our medical step therapy precertification review process.

Step therapy will apply to members upon precertification initiation in addition to the current medical necessity review.

Step therapy will not apply to members actively receiving the medications listed below.

Clinical Criteria Guidelines are publicly available at https://anthem.com/provider/medicare‑advantage. Visit the Clinical Criteria page to search for specific criteria.