UPDATE: Site of Care medical necessity reviews for long-acting colony-stimulating factors will no longer go into effect on August 1, 2021
This is an update to the article published in the April 2021 edition of Provider News regarding site of care medical necessity reviews for long-acting colony-stimulating factors.
The program will not be implemented on August 1, 2021. Medical necessity review of the site of care for the following long acting colony-stimulating factors for oncology indications will not be required beginning August 1, 2021, as originally communicated.
- Neulasta® and Neulasta Onpro® (pegfilgrastim)
- Fulphila® (pegfilgrastim-jmdb)
- Udenyca® (pegfilgrastim-cbqv)
- Ziextenzo® (pegfilgrastim-bmez)
- Nyvepria™ (pegfilgrastim-apgf)
There will be no changes for ordering providers who submit prior authorization requests for the hospital outpatient site of care for these medications for dates of service on or after August 1, 2021.
Providers should continue to verify eligibility and benefits for all members prior to rendering services.
If you have questions, please call the Provider Service phone number on the member’s ID card.
July 2021 Anthem Provider News - Virginia