MedicaidJune 30, 2023
Clinical Criteria Updates - September 2022
Summary: On May 20, 2022, August 19, 2022, and September 22, 2022, the Pharmacy and Therapeutic (P&T) Committee approved the following Clinical Criteria applicable to the medical drug benefit for Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem). These policies were developed, revised, or reviewed to support clinical coding edits.
Visit Clinical Criteria to search for specific policies. For questions or additional information, use this email.
Please see the explanation/definition for each category of Clinical Criteria below:
- New: newly published criteria
- Revised: addition or removal of medical necessity requirements, new document number
- Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive
Please share this notice with other providers in your practice and office staff.
Please note:
- The Clinical Criteria listed below applies only to the medical drug benefits contained within the member’s medical policy. This does not apply to pharmacy services.
- This notice is meant to inform the provider of new or revised criteria that has been adopted by Anthem only. It does not include details regarding any authorization requirements. Authorization rules are communicated via a separate notice.
Effective date | Document number | Clinical Criteria title | New or revised |
August 6, 2023 | *ING-CC-0018 | Pompe Disease | Revised |
August 6, 2023 | *ING-CC-0017 | Xiaflex (collagenase clostridium histolyticum) | Revised |
August 6, 2023 | ING-CC-0174 | Kesimpta (ofatumumab) | Revised |
August 6, 2023 | ING-CC-0089 | Mozobil (plerixafor) | Revised |
August 6, 2023 | ING-CC-0158 | Enhertu (fam-trastuzumab deruxtecan-nxki) | Revised |
August 6, 2023 | ING-CC-0130 | Imfinzi (durvalumab) | Revised |
August 6, 2023 | ING-CC-0097 | Vidaza (azacitidine) | Revised |
August 6, 2023 | *ING-CC-0072 | Vascular Endothelial Growth Factor Inhibitors | Revised |
August 6, 2023 | ING-CC-0063 | Stelara (ustekinumab) | Revised |
August 6, 2023 | *ING-CC-0002 | Colony Stimulating Factor Agents | Revised |
August 6, 2023 | *ING-CC-0107 | Bevacizumab for non-ophthalmologic indications | Revised |
August 6, 2023 | *ING-CC-0166 | Trastuzumab Agents | Revised |
NVBCBS-CD-013906-22
PUBLICATIONS: August 2023 Provider Newsletter
To view this article online:
Visit https://providernews.anthem.com/nevada/articles/clinical-criteria-updates-september-2022-14239
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