State & FederalMedicaidFebruary 28, 2021

Ocrevus/Vyepti Medical Step Therapy Notice

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

Effective for dates of service on and after April 1, 2021, the following specialty pharmacy drugs and corresponding codes from current Clinical Criteria noted below will be included in our medical step therapy precertification review process. Step therapy review applies upon precertification initiation or renewal in addition to the current medical necessity review.

 

Clinical Criteria

Status

Drug(s)

HCPCS codes

ING-CC-0011 

Nonpreferred

Ocrevus®, injection, 1 mg

J2350 

ING-CC-0160 

Nonpreferred

Eptinezumab, injection 1 mg

J3032 

 

The Clinical Criteria is publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.

 

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative.

 

NYE-NU-0288-20 January 2021

PUBLICATIONS: March 2021 Empire Provider News