Products & Programs PharmacyMedicare AdvantageMay 22, 2025

New specialty pharmacy medical step therapy requirements

Starting July 1, 2025, the following Part B medications from the current Clinical Criteria Guidelines will be included in our medical step therapy precertification review process.

Step therapy will apply to members upon precertification initiation in addition to the current medical necessity review.

Step therapy will not apply to members actively receiving the medications listed below.

Clinical Criteria Guidelines are publicly available at https://anthem.com/provider/medicare‑advantage. Visit the Clinical Criteria page to search for specific criteria.

Clinical UM Guidelines

Status

Drug(s)

CC-0072

Preferred

Pavblu (aflibercept-ayyh)

CC-0072

Non-preferred

Ahzantive (aflibercept-mrbb)

CC-0072

Non-preferred

Enzeevu (aflibercept-abzv)

CC-0072

Non-preferred

Opuviz (afibercept-yszy)

CC-0072

Non-preferred

Yesafili (aflibercept-jbvf)

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CR-081303-25-CPN81191

PUBLICATIONS: June 2025 Provider Newsletter