Anthem Blue Cross and Blue Shield | CommercialDecember 1, 2024
Notice of material change/amendment to contract
Clinical Criteria updates for specialty pharmacy
The following Clinical Criteria documents were endorsed at the September 20, 2024, Clinical Criteria meeting. Visit Clinical Criteria in Pharmacy to access the Clinical Criteria information.
New Clinical Criteria effective March 1, 2025
The following Clinical Criteria are new:
- CC-0269 Nemluvio (nemolizumab-ilto)
- CC-0271 Tecelra (afamitresgene autoleucel)
Revised Clinical Criteria effective March 1, 2025
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-0011 Ocrevus (ocrelizumab)/Ocrevus Zunovo (ocrelizumab/hyaluronidase-ocsq)
- CC-0012 Brineura (cerliponase alfa)
- CC-0029 Dupixent (dupilumab)
- CC-0072 Vascular Endothelial Growth Factor (VEGF) Inhibitors
- CC-0250 Veopoz (pozelimab-bbfg)
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MEBCBS-CM-072790-24-CPN72465
ATTACHMENTS: CC-0269 Nemluvio (final) (pdf - 0.14mb), CC-0271 Tecelra (final) (pdf - 0.16mb), CC-0011 Ocrevus; Ocrevus Zunovo (final) (pdf - 0.31mb), CC-0011 Ocrevus; Ocrevus Zunovo (redline) (pdf - 0.68mb), CC-0012 Brineura (final) (pdf - 0.16mb), CC-0012 Brineura (redline) (pdf - 0.64mb), CC-0029 Dupixent (final) (pdf - 0.35mb), CC-0029 Dupixent (redline) (pdf - 0.7mb), CC-0072 VEGF Inhibitors (final) (pdf - 0.29mb), CC-0072 VEGF Inhibitors (redline) (pdf - 0.75mb), CC-0250 Veopoz (final) (pdf - 0.17mb), CC-0250 Veopoz (redline) (pdf - 0.52mb)
PUBLICATIONS: December 2024 Provider Newsletter
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