Notice of changes to prior authorization requirements for Designated Specialty Pharmacy Network

Designated specialty pharmacy network updates

 

As we previously communicated, Anthem Blue Cross and Blue Shield (Anthem)’s Designated Specialty Pharmacy Network requires providers who are not part of the Designated Specialty Pharmacy Network to acquire certain select specialty pharmacy medications administered in the hospital outpatient setting through CVS Specialty Pharmacy.

 

This update is to advise of the following changes:

 

Effective for dates of service on and after June 30, 2021, the following specialty pharmacy medication will be added to the Designated Medical Specialty Pharmacy drug list. Accordingly, hospitals that are not in the Designated Specialty Pharmacy Network will be required to acquire this specialty medication administered in the hospital outpatient setting from CVS Specialty Pharmacy.

 

HCPCS	Description	Brand Name
Q5121	INJECTION, INFLIXIMAB-AXXQ, BIOSIMILAR 10MG	Avsola

 

Effective immediately, the following specialty pharmacy medications have been removed from the Designated Medical Specialty Pharmacy drug list:

 

HCPCS	Description	Brand Name
J0178	EYLEA	Eylea
J0588	INJECTION INCOBOTULINUMTOXIN 1 UNIT	Xeomin
J2353	INJ OCTREOTIDE DEPOT FORM IM 1MG	Sandostatin LAR Depot
J1930	SOMATULINE DEPOT	Somatuline Depot

 

To access the current Designated Medical Specialty Pharmacy drug list, please visit anthem.com, select Providers, select Ohio, under the Provider Resources column select Forms and Guides, scroll down and select Pharmacy in the Category drop down.

 

Note that the Designated Medical Specialty Pharmacy drug list may be updated periodically by Anthem.

 

If you have questions or would like to discuss the terms and conditions to be included as a Designated Specialty Pharmacy Network provider, please contact your Anthem Contract Manager.

 

Thank you for your continued participation in the Anthem networks and the services you provide to our members.

 

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