Products & Programs PharmacyCommercialFebruary 1, 2025

Designated specialty pharmacy network updates

Anthem has a policy requiring facilities to acquire certain select specialty pharmacy medications administered in the hospital outpatient setting through our contracted medical specialty pharmacy.

Updates

Effective for dates of service on and after April 1, 2025, the HCPCS code J2796 for Nplate (romiplostim), which is presently on the Designated Medical Specialty Pharmacy Drug List, will be replaced with HCPCS code J2802.

Additionally, effective for dates of service on and after April 1, 2025, the following specialty pharmacy medications will be removed from the Designated Medical Specialty Pharmacy Drug List and will no longer need to be obtained from our contracted medical specialty pharmacy:

HCPCS

Description

Brand name

J1950

INJ LEUPROLIDE ACETATE PER 3.75 MG

LUPRON DEPOT

J9217

LEUPROLIDE ACETATE 7.5 MG

ELIGARD/LUPRON DEPOT

J9218

LEUPROLIDE ACETATE, PER 1 MG

LUPRON

To access the current Designated Medical Specialty Pharmacy Drug List, please visit anthem.com/provider, select Providers, select Forms and Guides (under the Provider Resources column), select Missouri, scroll down, and select Pharmacy in the Category dropdown. 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 contract manager with Anthem. Thank you for your continued participation in the Anthem networks and the services you provide to our members. We are committed to a future of shared success.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MOBCBS-CM-074999-24

PUBLICATIONS: February 2025 Provider Newsletter