CommercialSeptember 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 June 10, 2024, Clinical Criteria meeting. To access the Clinical Criteria information, visit tinyurl.com/yfjtn5nf.
New Clinical Criteria effective December 1, 2024
The following Clinical Criteria is new:
- CC-0264 Anktiva (nogapendekin alfa inbekicept-pmln)
Revised Clinical Criteria effective December 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-0041 Complement C5 Inhibitors
- CC-0166 Trastuzumab Agents
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-064862-24
PUBLICATIONS: September 2024 Provider Newsletter
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