Effective for dates of service November 1, 2018, the following specialty pharmacy codes from new or current medical policies and/or clinical UM guidelines will be added to our existing level of care pre-service review process. 

 

Pre-service clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health® (AIM®), a separate company administering the program on behalf of Anthem, as applicable.

 

Level of care drug list additions

Clinical UM Guideline or Medical Policy

Drug Name

Drug Code(s)

CG-DRUG-78

HemlibraTM

Q9995

CG-DRUG-89

SublocadeTM

Q9991, Q9992

CG-DRUG-89

Probuphine®

J0570

CG-DRUG-05

Retacrit®

Q5106

 

In addition, effective immediately, the following specialty pharmacy codes from new or current medical policies and/ or clinical UM guidelines will be removed from our existing level of care pre-service review process. 

 

Level of care drug list deletions

Clinical UM Guideline or Medical Policy

Drug Name

Drug Code

CG-DRUG-100

Actimmune®

J9216

DRUG.00086

Increlex®

J2170

CG-DRUG-60

Firmagon®

J9155

 

View the Clinical Site of Care drug list and Clinical Site of Care pre-service clinical review FAQs for more information.

 



Featured In:
August 2018 Anthem New Hampshire Provider Newsletter