Update: Site of care medical necessity reviews for long-acting colony-stimulating factors not implemented on June 1, 2021*
*Notice of Material Amendment/Change to Contract (MAC)
This is an update to the article published in the March 2021 edition of Provider News regarding Site of Care medical necessity reviews for long-acting colony-stimulating factors effective June 1, 2021.
This program was not implemented on June 1, 2021, and it will not be implemented.
Medical necessity review of the site of care for the following long acting colony-stimulating factors for oncology indications will not be required as originally communicated.
- Neulasta® and Neulasta Onpro® (pegfilgrastim)
- Fulphila® (pegfilgrastim-jmdb)
- Udenyca® (pegfilgrastim-cbqv)
- Ziextenzo® (pegfilgrastim-bmez)
- Nyvepria™ (pegfilgrastim-apgf)
There have been no changes for ordering providers who submit prior authorization requests for the hospital outpatient site of care for these medications for dates of service on or after June 1, 2021.
Providers should continue to verify eligibility and benefits for all members prior to rendering services. If you have questions, please call the Provider Service phone number on the member’s ID card.
July 2021 Anthem Provider News - Ohio