In the December 2018 newsletter, Anthem Blue Cross and Blue Shield (Anthem) introduced the new clinical criteria page for injectable, infused or implanted drugs.

 

Effective for dates of service on and after August 1, 2019, the following new oncology clinical criteria will be included in our clinical criteria review process. The oncology drugs that require prior authorization will continue to require prior authorization notification with AIM. 

 

Existing precertification requirements have not changed for the specific Clinical Criteria below. While there are no material changes, the document number and online location has changed. You can go online to access the Clinical Criteria information.

 

The table below will assist you in identifying the new document number for the clinical criteria that corresponds with the previous Clinical Guideline/Medical Policy.

 

Anthem’s prior authorization clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health® (AIM), a separate company.

 

Clinical Guideline

Clinical Criteria Document Number

Clinical Criteria Name



Drug


HCPCS Code

CG-DRUG-76

ING-CC-0089

Mozobil (plerixafor)

Mozobil

J2562

 



Featured In:
July 2019 Anthem Provider News - Kentucky