Products & Programs PharmacyCommercialJune 30, 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 non-oncology 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 document was endorsed at the December 2, 2022, Clinical Criteria meeting. To access the Clinical Criteria information, visit this link. 

New Clinical Criteria effective October 1, 2023

The following Clinical Criteria is new:

  • CC-0238 Hydroxyprogesterone caproate

*Carelon Medical Benefits Management is an independent company providing some utilization review services on behalf of the health plan.

NYBCBS-CM-026907-23

PUBLICATIONS: July 2023 Provider Newsletter