CommercialMay 31, 2023
Clinical Criteria updates for specialty pharmacy
Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.
The Empire BlueCross BlueShield (Empire) preservice clinical review of nononcology specialty pharmacy drugs will be managed by the Medical Specialty Drug Review team of Empire. Oncology drugs will be managed by Carelon Medical Benefits Management,* a separate company.
The following Clinical Criteria documents were endorsed at the March 23, 2023, Clinical Criteria meeting. To access the Clinical Criteria information, visit this link.
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)
* Carelon Medical Benefits Management is an independent company providing some utilization review services on behalf of the health plan.
NYBCBS-CM-024683-23
PUBLICATIONS: June 2023 Provider Newsletter
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