MedicaidSeptember 1, 2022
New specialty pharmacy medical step therapy requirements
Effective for dates of service on and after September 15, 2022, the following specialty pharmacy codes from current or new Clinical Criteria documents will be included in our existing specialty pharmacy medical step therapy review process. Step therapy review will apply upon precertification initiation or renewal in addition to the current medical necessity review of all drugs noted below.
Clinical Criteria is publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.
Clinical Criteria |
Status |
Drug(s) |
HCPCS codes |
ING-CC-0075 ING-CC-0167 |
Preferred |
Riabni |
Q5123 |
ING-CC-0075 ING-CC-0167 |
Non-Preferred |
Rituxan |
J9312 |
ING-CC-0075 ING-CC-0167 |
Non-preferred |
Ruxience |
Q5119 |
ING-CC-0075 ING-CC-0167 |
Non-preferred |
Truxima |
Q5115 |
What if I need assistance?
If you have questions about this communication or need assistance with any other item, contact your assigned Provider Experience associate or call Provider Services at
855-661-2028.
PUBLICATIONS: September 2022 Anthem Provider News - Kentucky
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