Effective for dates of service on and after November 1, 2018, the following specialty pharmacy codes from new or current coverage guidelines will be included in our existing specialty pharmacy clinical site of care review process.

 

Pre-service clinical review of these specialty pharmacy drugs, including site of care criteria will be managed by Anthem Blue Cross and Blue Shield in Virginia and our affiliate, HealthKeepers, Inc.


Coverage or

Clinical Guideline

Drug

Code

CG-DRUG-78

HemlibraTM

Q9995

CG-DRUG-89

SublocadeTM

Q9991

Q9992

CG-DRUG-89

Probuphine®

J0570

CG-DRUG-05

Retacrit®

Q5106

 



Featured In:
August 2018 Anthem Provider Newsletter -- Virginia