Update on requirement to obtain certain specialty drugs from CVS Specialty Pharmacy effective October 1, 2021

As we previously communicated, Anthem Blue Cross and Blue Shield (Anthem) developed a policy requiring facilities to acquire certain select specialty pharmacy medications administered in the hospital outpatient setting through CVS Specialty Pharmacy.

 

This update is to advise of the following changes:

 

Effective for dates of service on and after October 1, 2021, the following specialty pharmacy medications will be added to the Designated Medical Specialty Pharmacy drug list and must be procured from CVS Specialty Pharmacy.

 

HCPCS	Description	Brand Name
Q5117	INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR 10MG	Kanjinti
J1558	INJECTION, IMMUNE GLOBULIN 100MG	Xembify
Q5123	INJECTION, RITUXIMAB-ARRX, BIOSIMILAR	Riabni

 

To access the current Designated Medical Specialty Pharmacy drug list, please visit anthem.com, select Providers, select Forms and Guides (under the Provider Resources column), select your state, scroll down and select Pharmacy in the Category drop down. The Designated Medical Specialty Pharmacy drug list may be updated periodically by Anthem.

 

If you have questions or would like to discuss the terms and conditions for providing certain specialty medications, please contact your Anthem Contract Manager. Thank you for your continued participation in the Anthem networks and the services you provide to our members.

 

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