Medicaid

 

Effective for dates of service on and after November 1, 2021, the following specialty pharmacy codes from current or new Clinical Criteria documents will require prior authorization.

 

Please note, inclusion of a national drug code on your claim will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.

 

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

 

Clinical Criteria

HCPCS or CPT® code(s)

Drug

Generic name

Drug class

ING-CC-0179

 J9037

Blenrep

Belantamab

Oncology

ING-CC-0180

 J9349

Monjuvi

Tafasitamab-cxix

Oncology

ING-CC-0181

J3490

Veklury

Remdesivir

COVID-19

 

 

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 844-396-2330.

ANV-NU-0272-21



Featured In:
October 2021 Anthem Provider News - Nevada