Anthem clinical criteria updates for specialty pharmacy are available effective for dates of service on and after June 1, 2022

Effective for dates of service on and after June 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-0062	Tumor Necrosis Factor Antagonists
ING-CC-0078	Orencia (abatacept)
ING-CC-0207	Vyvgart (efgartigimod alfa-fcab)
ING-CC-0208	Adbry (tralokinumab)
ING-CC-0209	Leqvio (inclisiran)

 

782-0322-PN-VA