CommercialJune 1, 2024
Clinical Criteria updates for specialty pharmacy
The pre-service clinical review of non-oncology specialty pharmacy drugs will be managed by the Medical Specialty Drug Review team at Anthem. Oncology drugs will be managed by Carelon Medical Benefits Management, Inc., a separate company.
The following Clinical Criteria documents were endorsed at the March 21, 2024, Clinical Criteria meeting. To access the Clinical Criteria information, visit this link.
Revised Clinical Criteria effective September 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-0003 Immunoglobulins
- CC-0062 Tumor necrosis factor antagonists
- CC-0125 Opdivo (nivolumab)
- CC-0251 Ycanth (cantharidin)
Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.
Commercial services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., or Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
NYBCBS-CM-058756-24
PUBLICATIONS: June 2024 Provider Newsletter
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