Products & Programs PharmacyAnthem Blue Cross and Blue Shield | CommercialFebruary 1, 2025

Clinical Criteria updates for specialty pharmacy are available

The following Clinical Criteria will be effective for dates of service on and after May 1, 2025.

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Aucatzyl (obecabtagene autoleucel)

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Agents for Hemophilia B

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Select Clotting Agents for Bleeding Disorders

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Agents for Hemophilia A and von Willebrand Disease

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Uplizna (inebilizumab‑cdon)

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Empaveli (pegcetacoplan)

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Complement Inhibitors

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Immunoglobulins

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Monoclonal Antibodies to Interleukin‑5

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Jemperli (dostarlimab‑gxly)

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Pemetrexed (Alimta, Pemfexy, Pemrydi)

Anthem will manage prior authorization of these specialty pharmacy drugs. Drugs used for the treatment of oncology will still require prior authorization by Carelon Medical Benefits Management, Inc. This applies to members enrolled in PPO and HMO plans.

Access the clinical criteria document information for details.

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.

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PUBLICATIONS: February 2025 Provider Newsletter