Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - March 2021

Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements starred (*) below.

 

• Site of Care medical necessity reviews for long-acting colony-stimulating factors begin June 1, 2021*
• Updates for specialty pharmacy are available – March 2021*
• Some HIV medication combinations may require prior authorization
• Anthem clarifies guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNF) facilities*
• Update: Notice of changes to the AIM Small Joint Surgery guideline