Anthem Blue Cross and Blue Shield | CommercialDecember 1, 2023
Clinical Criteria updates for specialty pharmacy are available
Effective for dates of service on and after March 1, 2024, the following Clinical Criteria updates might result in services that were previously covered to now be found not medically necessary.
Prior authorization of the below specialty pharmacy drugs will be managed by Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. Drugs used for the treatment of oncology will still require prior authorization by Carelon Medical Benefits Management, Inc. This notice applies to members with Preferred Provider Organization (PPO) and Anthem HealthKeepers (HMO).
Access the Clinical Criteria document information here.
CC-0018 | Pompe Disease |
CC-0233 | Rebyota (fecal microbiota, live – jslm) |
CC-0250 | Veopoz (pozelimab-bbfg) |
Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc.
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-043827-23
PUBLICATIONS: December 2023 Provider Newsletter
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