Missouri
Provider Communications
Specialty pharmacy updates - October 2022
Prior authorization clinical review of non-oncology use of specialty pharmacy drugs is managed by Anthem’s medical specialty drug review team. Review of specialty pharmacy drugs for oncology use is managed by AIM Specialty Health®* (AIM), a separate company.
Inclusion of the National Drug Code (NDC) on your claim will help expedite claim processing of drugs billed with a Not Otherwise Classified (NOC) code.
Step therapy updates
Effective for dates of service on and after January 1, 2023, the following specialty pharmacy codes from current or new Clinical Criteria documents will be included in our existing specialty pharmacy medical step therapy review process.
Please note that infliximab agents are subject to step therapy today, and this is to notify of the changes in the preferred and nonpreferred products. Inflectra will become non-preferred and Avsola will become preferred as of January 1, 2023.
Access our Clinical Criteria to view the complete information for these step therapy updates.
|
Clinical Criteria |
Status |
Drug |
HCPCS or CPT® code(s) |
|
ING-CC-0062 |
Preferred |
Avsola |
Q5121 |
|
ING-CC-0062 |
Preferred |
Infliximab Unbranded |
J1745 |
|
ING-CC-0062 |
Preferred |
Remicade |
J1745 |
|
ING-CC-0062 |
Nonpreferred |
Inflectra |
Q5103 |
|
ING-CC-0062 |
Nonpreferred |
Renflexis |
Q5104 |
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October 2022 Anthem Provider News - Missouri