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.

 

Effective for dates of service on and after November 1, 2021, the following specialty pharmacy codes from current or new Clinical Criteria documents will require prior authorization.

 

Please note, inclusion of a national drug code on your claim will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.

 

Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.

 

Clinical Criteria

HCPCS or CPT® code(s)

Drug

Generic name

Drug class

ING-CC-0179

 J9037

Blenrep

Belantamab

Oncology

ING-CC-0180

 J9349

Monjuvi

Tafasitamab-cxix

Oncology

ING-CC-0181

J3490

Veklury

Remdesivir

COVID-19

 

What if I need assistance?

 

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.

 

AVAPEC-3075-21



Featured In:
October 2021 Anthem Provider News - Virginia