HealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 25, 2025
Prior authorization updates for medications billed under the medical benefit
Effective for dates of service on or after April 1, 2025, the following specialty pharmacy codes from current or new Clinical Criteria documents will be included in our existing specialty pharmacy medical step therapy review process. Step therapy review will apply upon preapproval initiation or renewal in addition to the current medical necessity review of all drugs noted below.
The list of Clinical Criteria is publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.
Clinical Criteria | Status | Drug(s) | HCPCS codes |
CC‑0078 | Non‑Preferred | Orencia | J0129 |
CC‑0078 | Preferred | Avsola | Q5121 |
HealthKeepers, Inc. is an independent licensee of the Blue Cross Blue Shield Association. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
VABCBS-CD-072778-24-CPN72580
PUBLICATIONS: March 2025 Provider Newsletter
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