In the December 2018 newsletter, Anthem Blue Cross and Blue Shield (Anthem) introduced the new clinical criteria page for injectable, infused or implanted drugs.


Effective for dates of service on and after March 1, 2019, there will be new Clinical Criteria included in our Clinical Criteria review process. The drugs that require prior authorization will continue to require prior authorization notification with AIM Specialty Health.


Click here to see a list of Clinical Criteria updates for specialty pharmacy.

While there are no material changes, the document number and online location has changed. This list will assist you in identifying the new document number for the clinical criteria that corresponds with the previous Clinical Guideline/Medical Policy. Existing precertification requirements have not changed for the specific Clinical Criteria updates on this list.


Click here to access the Clinical Criteria information on our webpage.

Anthem’s prior authorization clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health®.

Featured In:
March 2019 Anthem Provider Newsletter - Wisconsin