Clinical Criteria updates for specialty pharmacy are available

Effective for dates of service on and after February 1, 2023, the following Clinical Criteria were developed 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). 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-0029	Dupixent (dupilumab)
ING-CC-0035	Duopa (carbidopa and levodopa enteral suspension)
ING-CC-0058	Byngezia Pen, Sandostatin, or Sandostatin LAR (Octreotide)/ Octreotide Agents
ING-CC-0142	Somatuline Depot (lanreotide)
ING-CC-0176	Beleodaq (belinostat)
ING-CC-0188	Imcivree (setmelanotide)

 

* 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-008721-22