State & FederalMedicaidNovember 1, 2019

June 2019 Medical Policies and Clinical Utilization Management Guidelines Update

Category: Medicaid

 

The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed.

 

Please share this notice with other members of your practice and office staff.

 

To view a guideline, visit https://www11.anthem.com/search.html.

 

Medical Policies

 

On June 6, 2019, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies applicable to Anthem Blue Cross and Blue Shield Medicaid (Anthem).

 

Publish date

Medical Policy number

Medical Policy title

New or revised

6/27/2019

DRUG.00046

Ipilimumab (Yervoy®)

Revised

6/27/2019

DRUG.00053

Carfilzomib (Kyprolis®)

Revised

6/27/2019

DRUG.00062

Obinutuzumab (Gazyva®)

Revised

6/27/2019

DRUG.00067

Ramucirumab (Cyramza®)

Revised

6/27/2019

DRUG.00071

Pembrolizumab (Keytruda®)

Revised

6/27/2019

DRUG.00075

Nivolumab (Opdivo®)

Revised

6/27/2019

DRUG.00107

Avelumab (Bavencio®)

Revised

 

Clinical UM Guidelines

 

On June 6, 2019, the MPTAC approved the following Clinical UM Guidelines applicable to Anthem. These guidelines were adopted by the medical operations committee for Anthem Blue Cross and Blue Shield Medicaid members on July 5, 2019.

 

Publish date

Clinical UM Guideline number

Clinical UM Guideline title

New or revised

6/27/2019

CG-DRUG-48

Azacitidine (Vidaza®)

Revised

6/27/2019

CG-DRUG-62

Fulvestrant (FASLODEX®)

Revised

6/27/2019

CG-DRUG-106

Brentuximab Vedotin (Adcetris)

Revised

6/27/2019

CG-DRUG-98

Bendamustine Hydrochloride

Revised

 

PUBLICATIONS: November 2019 Anthem Provider News - Kentucky