Effective for dates of service on and after January 1, 2019, the following drug codes from new or current medical policies or clinical UM guidelines will be included in our existing specialty pharmacy level of care pre-service clinical review process.

Level of care pre-service clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health® (AIM), a separate company

 

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

 

Medical Policy or Clinical UM Guideline

Drug

HCPCS or CPT Code

NDC Code

CG-DRUG-16

Fulphila™

Q5108

67457-0833-06



Featured In:
October 2018 Anthem New Hampshire Provider Newsletter