Anthem announces changes in medical non-oncology specialty drug reviews effective June 15, 2019

We continue to streamline our medical specialty drug reviews by transitioning another drug review process from AIM Specialty Health^® (AIM) to Anthem Blue Cross and Blue Shield (Anthem)’s medical specialty drug review team.

 

As a reminder, beginning on January 2019, providers are able to visit the Pharmacy Information page to review clinical criteria for all injectable, infused or implanted prescription drugs. 

 

What is changing?

Beginning on June 15, 2019, for all requests, regardless of service date, providers will need to submit a new prior authorization request by contacting Anthem’s medical specialty drug review team:

• By phone at 1-833-293-0659 or
• By fax at 1-888-223-0550 or
• Online access at www.Availity.com available 24/7.

All inquiries about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration will be managed by Anthem’s medical specialty drug review team.

 

What is not changing?

• AIM will continue to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
• Medical policies and clinical guidelines for non-drug specialty topics will continue to reside on the Policies webpage on anthem.com.

• Post Service Clinical Coverage Reviews and Grievance and Appeals process and teams will not change.

 

For your convenience here is a summary of the medical specialty drug changes:

 

Prior to June 15, 2019

Action	Contact
Submit a new prior authorization request   Inquire about an existing request	Call AIM at 866-714-1107, 8 a.m. – 5 p.m. or Access online at www.availity.com  available 24/7

 

Beginning June 15, 2019

Action	Contact
Submit a new prior authorization request for medical specialty drug reviews	Call Anthem at 1-833-293-0659 or fax us at 1-888-223-0550  or Access online at www.availity.com available 24/7
Inquire about an existing request (initially submitted to AIM or Anthem, peer-to-peer review, or reconsideration	Call Anthem at 1-833-293-0659