State & FederalMedicare AdvantageMarch 1, 2019

Clinical criteria updates for specialty pharmacy

The following revised clinical criteria will be effective May 1, 2019. Visit www.anthem.com/pharmacyinformation/clinicalcriteria to search for specific clinical criteria. Please share this notice with other members of your practice and office staff.

 

Clinical criteria effective date Clinical criteria number Clinical criteria Clinical criteria (new/revised)
May 1, 2019 ING-CC-0001 Erythropoiesis Stimulating Agents Revised
May 1, 2019 ING-CC-0004 H.P. Acthar Gel®(repository corticotropin injection) Revised
May 1, 2019 ING-CC-0072 Selective Vascular Endothelial Growth Factor (VEGF) Antagonists Revised