Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Clinical Criteria updates for specialty pharmacy are available

Effective on and after November 1, 2024, the following Clinical Criteria were developed 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 its 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 Carelon Medical Benefits Management, Inc., a separate company. This applies to members with Preferred Provider Organization (PPO), and Anthem HealthKeepers (HMO).

Clinical Criteria

Description

CC-0092

Adcetris (brentuximab vedotin)

CC-0098

Doxorubicin Liposome (Doxil, Lipodox)

CC-0105

Vectibix (panitumumab)

CC-0106

Erbitux (cetuximab)

CC-0107

Bevacizumab for Non-Ophthalmologic Indications

CC-0111

Nplate (romiplostim)

CC-0130

Imfinzi (durvalumab)

CC-0145

Libtayo (cemiplimab-rwlc)

CC-0162

Tepezza (teprotumumab-trbw)

Access the Clinical Criteria document information.

Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123, are independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

VABCBS-CM-062463-24

PUBLICATIONS: August 2024 Provider Newsletter