Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.


Effective for dates of service on and after January 1, 2021, the following specialty pharmacy drugs and corresponding codes from current Clinical Criteria will be included in our medical step therapy precertification review process. Step therapy review will apply upon precertification initiation or renewal, in addition to the current medical necessity review of all drugs noted below.


The Clinical Criteria below will be updated to include the requirement of a preferred agent effective January 1, 2021.


Clinical Criteria

Preferred drug

Nonpreferred drug


Herzuma (Q5113), Kanjinti (Q5117), Ogivri (Q5114), Ontruzant (Q5112), Trazimera (Q5116)

Herceptin (J9355)


Clinical Criteria is publicly available on our provider website at


If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.



Featured In:
November 2020 Anthem Provider News - Virginia