Products & Programs PharmacyCommercialMay 31, 2023

Clinical Criteria updates for specialty pharmacy

The following Clinical Criteria documents were endorsed at the March 23, 2023, Clinical Criteria meeting. Visit our website to access the Clinical Criteria information.

New Clinical Criteria effective September 1, 2023
The following Clinical Criteria are new:

  • CC-0235 Revcovi (elapegademase-lvlr)
  • CC-0236 Signifor LAR (pasireotide)

Revised Clinical Criteria effective September 1, 2023
The following Clinical Criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary:

  • CC-0034 Hereditary Angioedema Agents
  • CC-0065 Hemophilia A and von Willebrand Disease
  • CC-0119 Yervoy (ipilimumab)
  • CC-0197 Jemperli (dostarlimab-gxly)

MULTI-BCBS-CM-024829-23-SRS24682

PUBLICATIONS: June 2023 Provider Newsletter