Designated specialty pharmacy network updates

As we previously communicated, Anthem requires providers who are not part of our designated specialty pharmacy network to acquire certain select specialty pharmacy medications administered in the hospital outpatient setting through our contracted medical specialty pharmacy.

Updates

Effective for dates of service on and after April 1, 2025, the HCPCS code J2796 for Nplate (romiplostim), which is presently on the Designated Medical Specialty Pharmacy Drug List, will be replaced with J2802.

Additionally, effective for dates of service on and after April 1, 2025, the following specialty pharmacy medications will be removed from the Designated Medical Specialty Pharmacy Drug List and will no longer need to be obtained from our contracted medical specialty pharmacy:

To access the current Designated Medical Specialty Pharmacy Drug List, please visit anthem.com/provider, select Providers, select Forms and Guides (under the Provider Resources column), select your state, scroll down, and select Pharmacy in the Category dropdown. 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 contract manager with Anthem. Thank you for your continued participation in the Anthem networks and the services you provide to our members.