Specialty dose rounding program for certain non-oncology medications beginning August 1, 2021

Effective with dates of service on or after August 1, 2021, providers treating members covered by Anthem Blue Cross and Blue Shield (Anthem) Commercial plans may be asked to consider voluntarily reducing the requested dose to avoid vial wastage for select non-oncology specialty medications. The dose reduction suggestion will only be made if the originally requested dose is within 10% of the nearest whole vial.

 

Since this program is voluntary, the decision to participate will not affect the final decision on the prior authorization. 

 

Reviews for these specialty drugs will continue to be administered by IngenioRx_®.

 

As part of the prior authorization process, providers may be asked the following questions:

• Whether the suggested dose reduction is clinically acceptable
• Clinical reasoning if the dose reduction is not appropriate

 

Providers can view prior authorization requirements for Anthem members on the Medical Policy & Clinical UM Guidelines page at anthem.com.

 

Providers should continue to verify eligibility and benefits for all members prior to rendering services.

 

If you have questions, please call the Provider Service phone number on the back of the member’s ID card.

 

1273-0821-PN-CNT