Effective for dates of service on and after August 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-0033

Xolair (omalizumab)

ING-CC-0042

Monoclonal Antibodies to Interleukin-17

ING-CC-0050

Monoclonal Antibodies to Interleukin-23

ING-CC-0124

Keytruda (pembrolizumab)

ING-CC-0186

Margenza (margetuximab-cmkb)

ING-CC-0209

Leqvio (inclisiran)

ING-CC-0210

Enjaymo (sutimlimab-jome)

ING-CC-0212

Tezspire (tezepelumab-ekko)

ING-CC-0213

Voxzogo (vosoritide)

 

2071-0522-PN-VA



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May 2022 Anthem Provider News - Virginia