Designated specialty pharmacy network: Reminders and contact information
As a reminder, effective April 1, 2021, Anthem Blue Cross and Blue Shield (Anthem) implemented a designated network for select specialty pharmacy medications administered in the outpatient facility setting, Designated SRx Network. This applies to all Indiana Anthem Commercial members.
Facilities who are Designated SRx Network providers can continue to acquire and administer the specialty pharmacy medications covered under the member’s medical benefit plan.
Facilities who are not Designated SRx Network providers are required to acquire the select specialty pharmacy medications through CVS Specialty Pharmacy. The failure to do so may result in claim denials and the member cannot be billed for these specialty medications. For specialty pharmacy medications acquired through CVS Specialty Pharmacy, facilities may continue to submit a claim for administration of the specialty pharmacy medications, which will be reimbursed at the current contracted rates.
If you have questions, you may contact CVS Specialty Pharmacy through the Designated SRx Network dedicated contact information:
Designated medical specialty pharmacy drug list
To access the current designated medical specialty pharmacy drug list, visit anthem.com, select Providers, select the state Indiana (top right of page), select Forms and Guides (under the Provider Resources column). Scroll down and select Pharmacy in the Category drop down. Note that this list is subject to change. All specialty pharmacy prior authorization requirements will still apply and are the responsibility of the ordering provider.
June 2021 Anthem Provider News - Indiana