Anthem clinical criteria updates for specialty pharmacy are available
Effective for dates of service on and after May 1, 2020, the following current and new clinical criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary.
Visit the Clinical Criteria page to review specific guidelines.
For Anthem Blue Cross and Blue Shield and affiliate HealthKeepers, Inc., prior authorization of these specialty pharmacy drugs will be managed by Anthem. Drugs used for the treatment of Oncology will still require prior authorization by AIM Specialty Health® (AIM), a separate company.
- ING-CC-0041 Complement Inhibitors
- ING-CC-0042 Monoclonal Antibodies to Interleukin-17
- ING-CC-0065 Agents for Hemophilia A and von Willebrand Disease
- ING-CC-0148 Agents for Hemophilia B
- ING-CC-0149 Select Clotting Agents for Bleeding Disorders
- ING-CC-0150 Kymriah (tisagenlecleucel)
February 2020 Anthem Provider News - Virginia