*Change to Prior Authorization Requirements


As we previously communicated, Anthem Blue Cross and Blue Shield (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 January 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

Description

Brand Name

J1554

Injection, immune globulin (asceniv), 500 mg

Asceniv

J7204

Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu

Esperoct

J7208

Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u.

Jivi

J7212

Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram

Sevenfact

J9144

Injection, daratumumab, 10 mg and hyaluronidase-fihj

Darzalex Faspro

 

To access the current Designated Medical Specialty Pharmacy drug list, please visit anthem.com, select Providers, select Forms and Guides (under the Provider Resources column), select your state, scroll down and select Pharmacy in the Category drop down.  The Designated Medical Specialty Pharmacy drug list may be updated periodically by Anthem.

 

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.

 

1348-1021-PN-IN.MO.OH.WI



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October 2021 Anthem Provider News - Indiana