Key updates to the Designated Medical Specialty Pharmacy Drug List

We require care providers 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.

Code replacement

Effective for dates of service on and after August 1, 2025, the HCPCS code J1300 for Soliris (eculizumab), which is presently on the Designated Medical Specialty Pharmacy Drug List, will be replaced with J1299.

Medication removal

Additionally, effective for dates of service on and after August 1, 2025, the following specialty pharmacy medication 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 your state, select Forms and Guides (under the Provider Resources column), scroll down, and select Pharmacy. Note: The Designated Medical Specialty Pharmacy Drug List may be updated periodically.

If you have questions or want to discuss the terms and conditions for being included as a designated specialty pharmacy network care provider, don't hesitate to contact your provider relationship management representative. Thank you for your continued participation in our networks and your services to our members. We are committed to a future of shared success.