Anthem clinical criteria updates for specialty pharmacy are available

Effective for dates of service on and after August 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-0033	Xolair (omalizumab)
ING-CC-0042	Monoclonal Antibodies to Interleukin-17
ING-CC-0050	Monoclonal Antibodies to Interleukin-23
ING-CC-0124	Keytruda (pembrolizumab)
ING-CC-0186	Margenza (margetuximab-cmkb)
ING-CC-0209	Leqvio (inclisiran)
ING-CC-0210	Enjaymo (sutimlimab-jome)
ING-CC-0212	Tezspire (tezepelumab-ekko)
ING-CC-0213	Voxzogo (vosoritide)

 

2071-0522-PN-VA