Prior authorization updates for therapeutic duplication of specialty drugs

Therapeutic duplications are defined as concurrent use of two or more drugs in the same therapeutic class for the same indication. Anthem’s prior authorization criteria does not allow for certain drugs to be used in combination with each other if the drugs are in the same therapeutic class.

Starting June 1, 2024, if multiple drugs are prescribed in the same therapeutic class for the therapeutic classes listed in the Therapeutic duplication category column in the table below, providers will be required to obtain a prior authorization for each drug.

Example drugs for each therapeutic class are listed below. For a complete list for drugs that may not be used in combination, you can access our drug lists and formulary policies by visiting Pharmacy Information for Providers | Anthem.com.

As a reminder, prior authorizations may be submitted through any of the following ways:

• Online: Submit the prior authorization requests online through the CoverMyMeds website (covermymeds.com). Electronic submission will allow care providers to check the status of the prior authorization request in real time.
• Fax: Download prior authorization forms from anthem.com and fax the completed forms to the number on the fax form.
• Phone: Call Provider Services at the number on the back of your patient’s member ID card. Submitting requests online or via fax is preferred.

If you have any questions regarding this notice, please contact Provider Services at the number on the back of your patient’s member ID card.