Anthem Blue Cross and Blue Shield | CommercialDecember 1, 2024
Clinical Criteria updates for specialty pharmacy are available
Effective for dates of service on and after March 1, 2025, the following Clinical Criteria were developed and might result in services that were previously covered now being found to be not medically necessary.
CC-0012 | Brineura (cerliponase alfa) |
CC-0029 | Dupixent (dupilumab) |
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 enrolled in PPO and HMO plans.
Access the clinical criteria document information (carelonrx.com).
Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.
CarelonRx, Inc. is an independent company providing pharmacy benefit 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-071896-24
PUBLICATIONS: December 2024 Provider Newsletter
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