Anthem clinical criteria updates for specialty pharmacy are available

Effective for dates of service on and after February 1, 2022, the following current clinical criteria were revised 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 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 members with Preferred Provider Organization (PPO), Anthem HealthKeepers (HMO), POS AdvantageOne, and Act Wise (CDH plans).

 

Access the clinical criteria document information.

 

ING-CC-0001	Erythropoiesis Stimulating Agents
ING-CC-0027	Denosumab Agents
ING-CC-0029	Dupixent (dupilumab)
ING-CC-0038	Human Parathyroid Hormone Agents
ING-CC-0104	Levoleucovorin Agents
ING-CC-0156	Reblozyl (luspatercept)
ING-CC-0182	Iron Agents

 

1376-1121-PN-VA