Products & Programs PharmacyCommercialMarch 1, 2024

Clinical Criteria updates for specialty pharmacy

The Anthem pre-service clinical review of non-oncology specialty pharmacy drugs will be managed by the Medical Specialty Drug Review team of Anthem. Oncology drugs will be managed by Carelon Medical Benefits Management, Inc., a separate company.

The following Clinical Criteria documents were endorsed at the December 11, 2023, Clinical Criteria meeting. To access the Clinical Criteria information, visit this link.

New Clinical Criteria effective June 1, 2024

The following Clinical Criteria are new:

  • CC-0255 Loqtorzi (toripalimab-tpzi)
  • CC-0256 Rivfloza (nedosiran)

Revised Clinical Criteria effective June 1, 2024

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-0002 Colony Stimulating Factor Agents
  • CC-0107 Bevacizumab for Non-ophthalmologic Indications
  • CC-0110 Perjeta (pertuzumab)
  • CC-0185 Oxlumo (lumasiran)

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Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NYBCBS-CM-049891-24

PUBLICATIONS: March 2024 Provider Newsletter