As we previously communicated, Anthem’s Designated Specialty Pharmacy Network requires providers who are not part of the Designated Specialty Pharmacy Network to acquire certain select specialty pharmacy medications administered in the hospital outpatient setting through CVS Specialty Pharmacy.   

 

This update is to advise of the following changes:

 

Effective for dates of service on and after June 30, 2021, the following specialty pharmacy medication will be added to the Designated Medical Specialty Pharmacy drug list. Accordingly, hospitals that are not in the Designated Specialty Pharmacy Network will be required to acquire this specialty medication administered in the hospital outpatient setting from CVS Specialty Pharmacy.

 

HCPCS

Description

Brand Name

Q5121

Injection, Infliximab-Axxq, Biosimilar 10 mg

Avsola

 

Effective immediately, the following specialty pharmacy medications have been removed from the Designated Medical Specialty Pharmacy drug list:

 

HCPCS

Description

Brand Name

J0178

Eylea

Eylea

J0588

Injection Incobotulinum Toxin 1 unit

Xeomin

J2353

Inj Octreotide Depot Form IM 1 mg

Sandostatin LAR Depot

J1930

Somatuline Depot

Somatuline Depot

 

To access the current Designated Medical Specialty Pharmacy drug list, please visit anthem.com, select Providers, select your applicable state, select Forms and Guides (under the Provider Resources column), 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 to be included as a Designated Specialty Pharmacy Network provider, please contact your Contract Manager.  Thank you for your continued participation in the Anthem networks and the services you provide to our members.

 

1199-0621-PN-NE

 



Featured In:
June 2021 Anthem New Hampshire Provider News