Effective for dates of service on or after 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 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.

 

Clinical UM Guideline or Medical Policy

Drug Name

Drug Code(s)

DRUG.00098

Lutathera®

C9031, A9699, J9999

DRUG.00111

IlumyaTM

J3590

CG-DRUG-05

Retacrit®

Q5105, Q5106

CG-DRUG-16

FulphilaTM

J3590



Featured In:
August 2018 Anthem New Hampshire Provider Newsletter