Products & Programs PharmacyCommercialFebruary 1, 2024

Updated requirements to obtain certain specialty drugs from CVS Specialty Pharmacy

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

Updates

Effective for dates of service on and after May 1, 2024, the following specialty pharmacy medications will be removed from the Designated Medical Specialty Pharmacy Drug List:

HCPCS

Description

Brand name

J2503

Injection, pegaptanib sodium, 0.3 mg

MACUGEN

J9023

INJECTION AVELUMAB 10 MG

BAVENCIO

J9225

HISTRELIN IMPLANT VANTAS 50 MG

VANTAS

J9266

INJ PEGASPARGASE SINGLE DOSE VIAL

ONCASPAR

J0887 J0888

INJECTION EPOETIN BETA 1 MICROGRAM ESRD

INJECTION EPOETIN BETA 1 MICROGRAM NON-ESRD

MIRCERA

J0885

INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS

EPOGEN/PROCRIT

J0881 J0882

INJ DARBEPOETIN ALFA 1 MCG NON-ESRD

INJ DARBEPOETIN ALFA 1 MCG FOR ESRD

ARANESP

Q5106

INJ EPOETIN ALFA-EPBX NON-ESRD BIOSIMLR 1000 UNIT

RETACRIT

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 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 contract manager with Anthem. Thank you for your continued participation in the Anthem networks and for the services you provide to our members. Beyond simply signing a contract, care providers are part of a genuine collaboration aimed at improving the lives of real people.

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-048765-23

PUBLICATIONS: February 2024 Provider Newsletter