Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after November 1, 2023, the following Clinical Criteria were developed and could mean that services previously covered may now be considered not medically necessary.

For Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc., prior authorization(PA) of these specialty pharmacy drugs will be managed by Anthem. Drugs used for the treatment of oncology will still require PA by Carelon Medical Benefits Management, Inc.*

For more information, access the Clinical Criteria document information.