Effective for dates of service on and after February 1, 2022, the following current clinical criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary.

 

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.  This applies to members with Preferred Provider Organization (PPO), Anthem HealthKeepers (HMO), POS AdvantageOne, and Act Wise (CDH plans).

 

Access the clinical criteria document information.

 

ING-CC-0001

Erythropoiesis Stimulating Agents

ING-CC-0027

Denosumab Agents

ING-CC-0029

Dupixent (dupilumab)

ING-CC-0038

Human Parathyroid Hormone Agents

ING-CC-0104

Levoleucovorin Agents

ING-CC-0156

Reblozyl (luspatercept)

ING-CC-0182

Iron Agents

 

1376-1121-PN-VA



Featured In:
November 2021 Anthem Provider News - Virginia