Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after December 1, 2022, the following current Clinical Criteria were revised, and might result in services that were previously covered but may now be found to be not medically necessary.

 

For Anthem Blue Cross and Blue Shield and our 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 AIM Specialty Health^® (AIM*), a separate company. This applies to members with Preferred Provider Organization (PPO), Anthem HealthKeepers (HMO), POS AdvantageOne, and Act Wise (CDH plans).

 

Access the Clinical Criteria document information.

 

ING-CC-0041	Complement Inhibitors
ING-CC-0061	Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications
ING-CC-0150	Kymriah (tisagenlecleucel)

 

* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc.

 

VABCBS-CM-004231-22