Effective for dates of service on and after May 15, 2022, the following specialty pharmacy codes from current or new Clinical Criteria documents will be included in our existing specialty pharmacy medical step therapy review process. Step therapy review will apply upon precertification initiation or renewal in addition to the current medical necessity review of all drugs noted below.

 

Clinical Criteria is publicly available on our provider website. Visit the Clinical Criteria website to search for specific clinical criteria.

 

Clinical Criteria

Status

Drug(s)

HCPCS codes

ING-CC-0075

ING-CC-0167

Preferred

Riabni

Q5123

ING-CC-0075

ING-CC-0167

Non-Preferred

Rituxan

J9312

ING-CC-0075

ING-CC-0167

Non-preferred

Ruxience

Q5119

ING-CC-0075

ING-CC-0167

Non-preferred

Truxima

Q5115

 

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your assigned Provider Experience associate or call Provider Services at:

  • Hoosier Healthwise: 866-408-6132
  • Healthy Indiana Plan: 844-533-1995
  • Hoosier Care Connect: 844-284-1798

 

AIN-NU-0375-22 (AINPEC-3639-22)

 



Featured In:
May 2022 Anthem Provider News - Indiana