Reminder: changes to the process for medical non-oncology specialty drug reviews effective June 15, 2019

In the June 2019 edition of Provider News we announced the transition of the medical non-oncology specialty drug review process from AIM Specialty Health® (AIM) to Anthem’s medical specialty drug review team, effective June 15, 2019. Here’s a reminder of the changes.

 

What has changed?

• Beginning June 15, 2019, all new or reauthorization specialty drug review requests that were previously performed by AIM, providers need to contact Anthem’s medical specialty drug review team:
  • by phone at 1-833-293-0659
  • by fax at 1-888-223-0550
• All inquiries about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration are being managed by Anthem’s medical specialty drug review team.

 

What has not changed?

• AIM continues to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
• Specialty drug review processes not previously done by AIM remain unchanged.
• Clinical criteria for medical non-oncology specialty drugs continues to reside on the clinical criteria page on anthem.com.
• Post Service Clinical Coverage Reviews and Grievance and Appeals process and teams have not changed.

 

Here is a summary of the medical specialty drug changes:

	Action	Contact
Beginning June 15, 2019	Submit a new prior authorization request for a medical specialty drug review   Submit a reauthorization request for a medical specialty drug review previously performed by AIM	Call Anthem at 1-833-293-0659 or Fax Anthem at 1-888-223-0550
	Inquire about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration	Call Anthem at 1-833-293-0659