Oncology clinical criteria updates for specialty pharmacy

On December 1, 2018, Anthem introduced the new clinical criteria page for injectable, infused or implanted drugs.

 

Effective for dates of service on and after August 1, 2019, the following new oncology clinical criteria will be included in our clinical criteria review process.  The oncology drugs that require prior authorization will continue to require prior authorization notification with AIM. 

 

Existing precertification requirements have not changed for the specific Clinical Criteria below.  While there are no material changes, the document number and online location have changed.  Access the clinical criteria information online.   The table below will assist you in identifying the new document number for the clinical criteria that corresponds with the previous Clinical Guideline/Coverage Guideline.

 

For Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc., pre-service clinical review of these specialty pharmacy drugs will be managed by Anthem. Drugs used for the treatment of oncology will still require pre-service clinical review by AIM Specialty Health® (AIM), a separate company.

This applies to members with Preferred Provider Organization (PPO) plans, Anthem HealthKeepers (HMO) plans, POS AdvantageOne, and Act Wise (CDH plans).

Clinical Guideline	Clinical Criteria Document Number	Clinical Criteria Name	Drug	HCPCS Code
CG-DRUG-76	ING-CC-0089	Mozobil (plerixafor)	Mozobil	J2562