Virginia
Provider Communications
Certain specialty medication precertification requests may require additional documentation
Please note, this communication applies to Anthem HealthKeepers Plus, Medallion and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc.
As part of our ongoing quality improvement efforts, HealthKeepers, Inc. is updating our precertification processes for certain specialty medications. Effective August 1, 2021, we may request additional documentation for impacted medications to determine medical necessity.
Upon request, providers shall submit documentation from the member’s medical record for each policy question flagged for documentation. A denial may result if documentation does not support medical necessity.
Should you have any questions, please refer to the Clinical Criteria policy website for specific medication criteria details.
Impacted policy |
Impacted medication(s) |
ING-CC-0153: Adakveo (crizanlizumab) |
Adakveo |
ING-CC-0065: Agents for Hemophiilia A and von Willebrand Disease |
Advate, Adynovate, Afstyla, Alphanate, Eloctate, Esperoct, Helixate FS, Hemlibra, Hemofil-M, Humate-P, Jivi, Koate-DVI, Kogenate FS, Kovaltry, Monoclate-P, Novoeight, Nuwiq, Obizur, Recombinate, Wilate, Xyntha |
ING-CC-0148: Agents for Hemophilia B |
Alphanine SD, Alprolix, Bebulin, Benefix, Idelvion, Ixinity, Mononine, Profilnine SD, Rebinyn, Rixubis |
ING-CC-0025: Aldurazyme (laronidase) |
Aldurazyme |
ING-CC-0073: Alpha-1 Proteinase Inhibitor Therapy |
Aralast, Glassia, Prolastin-C, Zemaira |
ING-CC-0028: Benlysta (belimumab) |
Benlysta |
ING-CC-0012: Brineura (cerliponase alfa) |
Brineura |
ING-CC-0137: Cablivi (caplacizumab-yhdp) |
Cablivi |
ING-CC-0041: Complement Inhibitors |
Soliris, Ultomiris |
ING-CC-0081: Crysvita (burosumab-twza) |
Crysvita |
ING-CC-0035: Duopa (carbidopa and levodopa enteral suspension) |
Duopa |
ING-CC-0029: Dupixent (dupilumab) |
Dupixent |
ING-CC-0069: Egrifta (tesamorelin) |
Egrifta |
ING-CC-0024: Elaprase (idursufase) |
Elaprase |
ING-CC-0173: Enspryng (satralizumab-mwge) |
Enspryng |
ING-CC-0051: Enzyme Replacement Therapy for Gaucher Disease |
Cerezyme, Elelyso, Vpriv |
ING-CC-0044: Exondys 51 (eteplirsen) |
Exondys 51 |
ING-CC-0021: Fabrazyme (agalsidase beta) |
Fabrazyme |
ING-CC-0068: Growth hormone |
Genotropin, Humatrope, Norditropin, Nutropin AQ, Omnitrope, Saizen, Serostim, Zomacton, Zorbtive |
ING-CC-0034: Hereditary Angioedema Agents |
Berinert, Cinryze, Firazyr, Haegarda, Kalbitor, Ruconest, Takhzyro |
ING-CC-0188: Imcivree (setmelanotide) |
Imcivree |
ING-CC-0070: Jetrea (ocriplasmin) |
Jetrea |
ING-CC-0037: Kanuma (sebelipase alfa) |
Kanuma |
ING-CC-0057: Krystexxa (pegloticase) |
Krystexxa |
ING-CC-0018: Lumizyme (alglucosidase alfa) |
Lumizyme |
ING-CC-0013: Mepsevii (vestronidase alfa) |
Mepsevii |
ING-CC-0043: Monoclonal Antibodies to Interleukin-5 |
Cinqair, Fasenra, Nucala |
ING-CC-0023: Naglazyme (galsulfase) |
Naglazyme |
ING-CC-0111: Nplate (romiplostim) |
Nplate |
ING-CC-0082: Onpattro (patisiran) |
Onpattro |
ING-CC-0077: Palynziq (pegvaliase-pqpz) |
Palynziq |
ING-CC-0049: Radicava (edaravone) |
Radicava |
ING-CC-0156: Reblozyl (luspatercept) |
Reblozyl |
ING-CC-0159: Scenesse (afamelanotide) |
Scenesse |
ING-CC-0149: Select Clotting Agents for Bleeding Disorders |
Feiba, Novoseven |
ING-CC-0079: Strensiq (asfotase alfa) |
Strensiq |
ING-CC-0008: Subcutaneous Hormonal Implants |
Testopel |
ING-CC-0084: Tegsedi (inotersen) |
Tegsedi |
ING-CC-0162: Tepezza (teprotumumab-trbw) |
Tepezza |
ING-CC-0170: Uplizna (inebilizumab) |
Uplizna |
ING-CC-0022: Vimizim (elosulfase alfa) |
Vimizim |
ING-CC-0152: Vyondys 53 (golodirsen) |
Vyondys 53 |
ING-CC-0017: Xiaflex (clostridial collagenase histolyticum) injection |
Xiaflex |
ING-CC-0033: Xolair (omalizumab) |
Xolair |
If you have any questions about this communication, call Anthem HealthKeepers Plus, Medallion Provider Services at 800‑901‑0020 or Anthem CCC Plus Provider Services at 855‑323‑4687.
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July 2021 Anthem Provider News - Virginia