Medicare AdvantageMay 22, 2025
New specialty pharmacy medical step therapy requirements
Starting July 1, 2025, the following Part B medications from the current Clinical Criteria Guidelines will be included in our medical step therapy precertification review process.
Step therapy will apply to members upon precertification initiation in addition to the current medical necessity review.
Step therapy will not apply to members actively receiving the medications listed below.
Clinical Criteria Guidelines are publicly available at https://anthem.com/provider/medicare‑advantage. Visit the Clinical Criteria page to search for specific criteria.
Clinical UM Guidelines | Status | Drug(s) |
CC-0072 | Preferred | Pavblu (aflibercept-ayyh) |
CC-0072 | Non-preferred | Ahzantive (aflibercept-mrbb) |
CC-0072 | Non-preferred | Enzeevu (aflibercept-abzv) |
CC-0072 | Non-preferred | Opuviz (afibercept-yszy) |
CC-0072 | Non-preferred | Yesafili (aflibercept-jbvf) |
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-081303-25-CPN81191
PUBLICATIONS: June 2025 Provider Newsletter
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