Effective for dates of service on and after May 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 its 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 consumers with Preferred Provider Organization (PPO), Anthem HealthKeepers (HMO), POS AdvantageOne, and Act Wise (CDH) plans.

 

Access the Clinical Criteria document information:

 

CC-0003

Immunoglobulins

CC-0062

Tumor necrosis factor antagonists

CC-0100

Istodax (romidepsin)

CC-0168

Tecartus (brexucabtagene autoleucel)

CC-0205

Fyarro (siroliumus albumin bound)

 

* 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.


VABCBS-CM-015978-22



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February 2023 Anthem Provider News - Virginia