Anthem expands specialty pharmacy clinical site of care (level of care) drug list

Effective for dates of service on and after November 1, 2018, the following specialty pharmacy codes from new or current coverage guidelines will be included in our existing specialty pharmacy clinical site of care review process.

 

Pre-service clinical review of these specialty pharmacy drugs, including site of care criteria will be managed by Anthem Blue Cross and Blue Shield in Virginia and our affiliate, HealthKeepers, Inc.

Coverage or Clinical Guideline	Drug	Code
CG-DRUG-78	HemlibraTM	Q9995
CG-DRUG-89	SublocadeTM	Q9991 Q9992
CG-DRUG-89	Probuphine®	J0570
CG-DRUG-05	Retacrit®	Q5106