Anthem clinical criteria updates for specialty pharmacy are available

Effective for dates of service on and after May 1, 2020, the following current and new clinical criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary.

 

Visit the Clinical Criteria page to review specific guidelines.

 

For Anthem Blue Cross and Blue Shield and 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.

• ING-CC-0041  Complement Inhibitors

 

• ING-CC-0042 Monoclonal Antibodies to Interleukin-17

 

• ING-CC-0065 Agents for Hemophilia A and von Willebrand Disease

 

• ING-CC-0148    Agents for Hemophilia B

 

• ING-CC-0149    Select Clotting Agents for Bleeding Disorders

 

• ING-CC-0150    Kymriah (tisagenlecleucel)