Effective for dates of service on and after November 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.


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-0002 Colony Stimulating Factor Agents


  • ING-CC-0003  Immunoglobulins


  • ING-CC-0032 Botulinum Toxin


  • ING-CC-0044 Exondys 51 (eteplirsen)


  • ING-CC-0098 Doxorubicin Liposome (Doxil, Lipodox)


  • ING-CC-0099 Abraxane (paclitaxel, protein bound)


  • NG-CC-0105 Vectibix (panitumumab)


  • ING-CC-0106 Erbitux (cetuximab)


  • ING-CC-0107 Bevacizumab for Non-Ophthalmologic Indications


  • ING-CC-0124 Keytruda (pembrolizumab)


  • ING-CC-0128 Tecentriq (atezolizumab)


  • ING-CC-0153 Adakveo (crizanlizumab)



Featured In:
August 2020 Anthem Provider News - Virginia