Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageApril 18, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025, the following Medicare Part B medication from the current Clinical Criteria Guidelines will be included in our medical step therapy preapproval review process. Step therapy review will apply upon preapproval initiation in addition to the current medical necessity review (as is current procedure). Step therapy will not apply for members who are actively receiving the medication listed below.

Visit our Clinical Criteria page to search for specific criteria.

Clinical Criteria

Drug

Status

CC‑0166

Hercessi (trastuzumab‑strf)

Non‑preferred

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.

Plans offered by AMH Health, LLC., a joint venture between MaineHealth and Anthem Partnership Holding Company, LLC. AMH Health is an independent licensee of the Blue Cross Blue Shield Association.

MULTI-BCBS-CR-077570-25-CPN77133

PUBLICATIONS: May 2025 Provider Newsletter