Clinical Criteria updates for specialty pharmacy

The following Clinical Criteria documents were endorsed at the August 18, 2023, Clinical Criteria meeting. Visit our website to access the Clinical Criteria information.

Revised Clinical Criteria effective February 1, 2024

The following Clinical Criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary:

• CC-0034 Hereditary Angioedema Agents
• CC-0041 Complement Inhibitors
• CC-0072 Vascular Endothelial Growth Factor (VEGF) Inhibitors
• CC-0119 Yervoy (ipilimumab)
• CC-0124 Keytruda (pembrolizumab)
• CC-0125 Opdivo (nivolumab)
• CC-0182 Iron Agents

Note: The applicable policies are attached to this article in PDF format.

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