Prior authorization required for specialty pharmacy -- May

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

 

Visit the Clinical Criteria website to search for specific clinical criteria. Please note, these codes are specific to Agents for Iron Deficiency Anemia. The Clinical Criteria indicated below can be found at: https://www.anthem.com/ms/pharmacyinformation/Agents-for-Iron-Deficiency-Anemia.pdf.

 

Clinical Criteria	HCPCS or CPT® code(s)	Drug
ING-CC-0182	J1756	Venofer
ING-CC-0182	J2916	Ferrlecit
ING-CC-0182	J1750	Infed
ING-CC-0182	J1439	Injectafer
ING-CC-0182	Q0138	Feraheme
ING-CC-0182	J1437	Monoferric

 

If you have questions about this communication or need further assistance, contact your local Provider Relations representative or call Provider Services at 1-844-396-2330.

 

 

ANV-NU-0201-21