Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingAugust 9, 2024
New prior authorization and specialty pharmacy medical step therapy requirements
Prior authorization updates
Effective for dates of service on and after July 1, 2023, the following specialty pharmacy codes from current or new Clinical Criteria documents will require prior authorization.
The list of Clinical Criteria is publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.
Clinical Criteria | HCPCS codes | Drug(s) |
Q5126 | Alymsys (bevacizumab-maly) | |
Q5126 | Alymsys (bevacizumab-maly) |
Step therapy updates
Effective for dates of service on and after July 1, 2023, the following specialty pharmacy code 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 prior authorization initiation or renewal in addition to the current medical necessity review of the drug noted below.
Clinical Criteria | Status | Drug(s) | HCPCS codes |
Non-preferred | Alymsys | Q5126 |
Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.
INBCBS-CD-029186-23
PUBLICATIONS: September 2024 Provider Newsletter
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