Effective for dates of service on and after February 1, 2023, the following Clinical Criteria were developed 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). 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



Dupixent (dupilumab)


Duopa (carbidopa and levodopa enteral suspension)


Byngezia Pen, Sandostatin, or Sandostatin LAR (Octreotide)/ Octreotide Agents


Somatuline Depot (lanreotide)


Beleodaq (belinostat)


Imcivree (setmelanotide)


* 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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November 2022 Anthem Provider News - Virginia