Reminder: Process change for medical non-oncology specialty drug reviews effective June 15, 2019

In the June 2019 issue of Provider News we announced the transition of the medical non-oncology specialty drug review process from AIM Specialty Health® (AIM) to Anthem’s medical specialty drug review team, effective June 15, 2019. Here’s a reminder of the changes.

 

What has changed?

• Beginning June 15, 2019, for all new specialty drug review requests and reauthorization specialty drug review requests that were previously performed by AIM, providers need to contact Anthem’s medical specialty drug review team:
  • by phone at 833-293-0659 or
  • by fax at 888-223-0550
• All inquiries about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration are being managed by Anthem’s medical specialty drug review team.

 

What has not changed?

• AIM continues to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
• Specialty drug review processes not previously done by AIM remain unchanged.
• Clinical criteria for medical non-oncology specialty drugs continues to reside on the clinical criteria page on anthem.com.
• Post service clinical coverage reviews and grievance and appeals process and teams have not changed.

 

Here is a summary of the medical specialty drug changes beginning June 15, 2019:

Action	Contact
Submit a new prior authorization request for a medical specialty drug review   Submit a reauthorization request for a medical specialty drug review previously performed by AIM	Call Anthem at 833-293-0659 or Fax Anthem at 888-223-0550
Inquire about an existing request (initially submitted to AIM or Anthem, peer-to-peer review, or reconsideration	Call Anthem at 833-293-0659