Effective for dates of service on and after December 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 our 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.



Complement Inhibitors


Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications


Kymriah (tisagenlecleucel)


* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc.



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September 2022 Anthem Provider News - Virginia