State & FederalMedicaidJune 1, 2019

Medical Policies and Clinical Utilization Management Guidelines Update -- June 2019

The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed 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. For markets with carved-out pharmacy services, the applicable listings below are informational only.

 

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

 

To search for specific policies or guidelines, visit https://www11.anthem.com/search.html.

 

Updates:

  • The InterQual 2019 version release takes effect on May 1, 2019.

 

Medical Policies

On November 21, 2018, 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 #

Medical Policy title

New or revised

12/12/2018

DRUG.00090

Bezlotoxumab (ZINPLAVA™)

Revised

11/15/2018

DRUG.00046

Ipilimumab (Yervoy®)

Revised

11/15/2018

DRUG.00075

Nivolumab (Opdivo®)

Revised

12/12/2018

DRUG.00062

Obinutuzumab (Gazyva®)

Revised

11/15/2018

DRUG.00071

Pembrolizumab (Keytruda®)

Revised

 

Clinical UM Guidelines

On November 21, 2018, 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 January 3, 2019.

 

Publish date

Clinical UM Guideline #

Clinical UM Guideline title

New or revised

11/15/2018

CG-DRUG-88

Dupilumab (Dupixent®)

Revised

12/12/2018

CG-DRUG-107

Pharmacotherapy for Hereditary Angioedema

Revised

12/12/2018

CG-DRUG-63

Levoleucovorin Products Previously title: Levoleucovorin Calcium (Fusilev®)

Revised

12/12/2018

CG-DRUG-65

Tumor Necrosis Factor Antagonists

Revised

12/12/2018

CG-DRUG-78

Antihemophilic Factors and Clotting Factors

Revised

 

AKY-NU-0143-19

 

PUBLICATIONS: June 2019 Anthem Provider Newsletter - Kentucky