Products & Programs PharmacyCommercialJune 30, 2022

Clinical Criteria updates for specialty pharmacy

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Material Adverse Change (MAC)

 

The Empire BlueCross BlueShield (Empire) pre-service clinical review of non-oncology specialty pharmacy drugs will be managed by Empire’s Medical Specialty Drug Review team. Oncology drugs will be managed by AIM Specialty Health® (AIM),* a separate company.

 

The following clinical criteria document was endorsed at the April 19, 2022, Clinical Criteria meeting. To access the clinical criteria information, please select here.

 

New clinical criteria effective September 1, 2022

The following clinical criteria is new:

  • ING-CC-0200 Aduhelm (aducanumab-avwa)

 

*AIM Specialty Health is an independent company providing some utilization review services on behalf of Empire BlueCross BlueShield

 

NYBCBS-COMM-001677-22

 

PUBLICATIONS: July 2022 Newsletter