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

Effective for dates of service on and after May 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-0042	Monoclonal Antibodies to Interleukin-17
ING-CC-0043	Monoclonal Antibodies to Interleukin-5
ING-CC-0049	Radicava (edaravone)
ING-CC-0050	Monoclonal Antibodies to Interleukin-23
ING-CC-0063	Stelara (ustekinumab)
ING-CC-0064	Interleukin-1 Inhibitors
ING-CC-0065	Agents for Hemophilia A and von Willebrand Disease
ING-CC-0066	Monoclonal Antibodies to Interleukin-6
ING-CC-0068	Growth Hormone
ING-CC-0071	Entyvio (vedolizumab)
ING-CC-0148	Agents for Hemophilia B
ING-CC-0149	Select Clotting Agents for Bleeding Disorders
ING-CC-0168	Tecartus (brexucabtagene autoleucel)
ING-CC-0195	Abecma (idecabtagene vicleucel)

 

1525-0222-PN-VA