Specialty dose rounding program for certain non-oncology medications effective August 1, 2021
We are committed to being a valued healthcare partner in identifying ways to achieve better health outcomes, lower costs and deliver access to a better healthcare experience for consumers.
Effective with dates of service on or after August 1, 2021, providers treating members covered by Anthem Commercial plans may be asked to consider voluntarily reducing the requested dose to avoid vial wastage for select non-oncology specialty medications. The dose reduction suggestion will only be made if the originally requested dose is within 10% of the nearest whole vial.
Since this program is voluntary, the decision to participate will not affect the final decision on the prior authorization.
Reviews for these specialty drugs will continue to be administered by IngenioRx®.
As part of the prior authorization process, providers may be asked the following questions:
- Whether the suggested dose reduction is clinically acceptable
- Clinical reasoning if the dose reduction is not appropriate
Providers can view prior authorization requirements for Anthem members on the Medical Policy & Clinical UM Guidelines page at anthem.com.
Providers should continue to verify eligibility and benefits for all members prior to rendering services.
If you have questions, please call the Provider Service phone number on the back of the member’s ID card.
August 2021 Maine Provider News