Products & Programs PharmacyCommercialNovember 30, 2020

Clinical Criteria updates for specialty pharmacy are available

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

Empire BlueCross BlueShield’s (“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 documents were endorsed at the October 23, 2020 Clinical Criteria meeting. To access the clinical criteria information please click here.

 

New Clinical Criteria effective October 30, 2020

The following clinical criteria is new.

  • ING-CC-0181 Veklury (remdesivir)

 

Revised Clinical Criteria effective February 1, 2021

The following current clinical criteria was revised and might result in services that were previously covered but may now be found to be not medically necessary.

  • ING-CC-0011 Ocrevus (ocrelizumab)

 

Revised Clinical Criteria effective March 1, 2021

The following current clinical criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary.

  • ING-CC-0078 Orencia (abatacept)
  • ING-CC-0174 Kesimpta (ofatumumab)

 

New Clinical Criteria effective March 1, 2021

The following clinical criteria is new.

  • ING-CC-0182 Agents for Iron Deficiency Anemia

 

837-1220-PN-NY

 

PUBLICATIONS: December 2020 Empire Provider News