Effective with dates of service on or after August 1, 2021, providers treating members covered by Anthem Blue Cross and Blue Shield (Anthem) Commercial plans may be asked to consider voluntarily using adjusted body weight (AdjBW) dosing compared to actual body weight (ABW) dosing for immune globulin medications. The dose change using AdjBW will only be made if the member’s actual body weight is more than 20% of the ideal body weight (IBW).

 

Since this program is voluntary, the decision to participate will not affect the final decision on the prior authorization.

 

Reviews for the immune globulin medications will continue to be administered by IngenioRx® as these will specifically target specialty non-oncology indications.

 

As part of the prior authorization process, providers may be asked the following questions:

  • Whether the suggested use of AdjBW and change in dose is clinically acceptable
  • Clinical reasoning if the dose change (using AdjBW) is not appropriate

 

Providers can view prior authorization requirements for Anthem members on the Medical Policy & Clinical UM Guidelines page at anthem.com.

 

Providers should continue to verify eligibility and benefits for all members prior to rendering services.

 

If you have questions, please call the Provider Service phone number on the back of the member’s ID card.

 

1274-0821-PN-CNT



Featured In:
August 2021 Anthem Provider News - Wisconsin