Anthem expands specialty pharmacy prior authorization 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 pre-service review process.

 

The following coverage guidelines will be effective November 1, 2018.

 

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

 

Coverage or Clinical Guideline	Code	Drug	Comments
DRUG.00098	C9031 A9699 J9999	Lutathera®	New Coverage Guideline
DRUG.00111	J3590	IlumyaTM	New Drug to Existing Guideline
CG-DRUG-05	Q5105 Q5106	Retacrit®	New Drug to Existing Guideline
CG-DRUG-16	J3590	FulphilaTM	New Drug to Existing Guideline