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

Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after February 1, 2025, 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.

Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. will manage prior authorization for these specialty pharmacy drugs. 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 a PPO and an HMO.

Access the Clinical Criteria document information for details.

CC-0028

Benlysta (belimumab)

CC-0034

Hereditary Angioedema Agents

CC-0096

Asparagine Specific Enzymes

CC-0156

Reblozyl (luspatercept)

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-069584-24

PUBLICATIONS: November 2024 Provider Newsletter