Voluntary site of care outreach for oncology checkpoint inhibitors beginning August 1, 2020
We are committed to being a valued health care 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, 2020, members with commercial plans covered by Anthem will be contacted to voluntarily redirect services to home infusion site of care from hospital outpatient site of care for certain immuno-oncology drugs (Bavencio® [avelumab], Imfinzi® [durvalumab], Keytruda® [pembrolizumab], Opdivo® [nivolumab], Tecentriq® [atezolizumab], and Yervoy® [ipilimumab]). Reviews for these oncology drugs will continue to be administered by AIM Specialty Health® (AIM).
The voluntary site of care redirection only applies to these specific drugs administered in an outpatient hospital setting. This does not apply to requests for these specific drugs when administered in a non-hospital setting or as part of an inpatient stay. The redirection also does not apply when Anthem is the secondary payer.
Please note, this review does not apply to the following plans: BlueCard®, Federal Employee Program® (FEP®), Medicaid, Medicare Advantage, Medicare Supplemental plans. 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.
Note: In some plans “site of service” or another term such as “setting” or “place of service” may be the term used in benefit plans, provider contracts or other materials instead of or in addition to “site of care” and in some plans, these terms may be used interchangeably. For simplicity, we will hereafter use “site of care.”
August 2020 Anthem Maine Provider News