Products & Programs PharmacyAnthem 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)