Medicare AdvantageApril 18, 2025
New specialty pharmacy medical step therapy requirement
Effective June 1, 2025, the following Medicare Part B medication from the current Clinical Criteria Guidelines will be included in our medical step therapy preapproval review process. Step therapy review will apply upon preapproval initiation in addition to the current medical necessity review (as is current procedure). Step therapy will not apply for members who are actively receiving the medication listed below.
Visit our Clinical Criteria page to search for specific criteria.
Clinical Criteria | Drug | Status |
CC‑0166 | Hercessi (trastuzumab‑strf) | Non‑preferred |
Medicare services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC., or Anthem Blue Cross and Blue Shield Retiree Solutions, trade name of Anthem Insurance Companies, Inc.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CR-077570-25-CPN77133
PUBLICATIONS: May 2025 Provider Newsletter
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