Designated specialty pharmacy network*
Beginning June 1, 2021, Anthem Blue Cross and Blue Shield (Anthem) is implementing a designated network for select specialty pharmacy medications administered in the outpatient facility setting, Designated SRx Network. This applies to all Anthem Ohio commercial members.
Providers who are Designated SRx Network providers can continue to acquire and administer the specialty pharmacy medications covered under the member’s medical benefit plan.
Providers who are not Designated SRx Network providers will be required to acquire the select specialty pharmacy medications administered in the hospital outpatient setting through CVS Specialty Pharmacy. The failure to do so may result in claim denials and the member cannot be billed for these specialty medications. Providers may continue to submit a claim for administration of the specialty pharmacy medications, which will be reimbursed at the current contracted rates.
The list of specialty pharmacy medications subject to the above will be posted at anthem.com for reference and is subject to change. All specialty pharmacy prior authorization requirements will still apply and are the responsibility of the ordering provider.
This will have no impact on how members obtain non-specialty pharmacy medications at retail pharmacies or by mail-order.
To access the current Designated Medical Specialty Pharmacy Drug List, visit anthem.com, select Providers, select the state Ohio (top right of page), select Forms and Guides (under the Provider Resources column). Scroll down and select Pharmacy in the Category drop down.
If you are interested in participating in the Designated SRx Network, please contact your provider contracting representative for more details.
February 2021 Anthem Provider News - Ohio