Products & Programs PharmacyCommercialFebruary 1, 2025

Designated specialty pharmacy network updates

As we previously communicated, Anthem requires providers who are not part of our designated specialty pharmacy network to acquire certain select specialty pharmacy medications administered in the hospital outpatient setting through our contracted medical specialty pharmacy.

Updates

Effective for dates of service on and after April 1, 2025, the HCPCS code J2796 for Nplate (romiplostim), which is presently on the Designated Medical Specialty Pharmacy Drug List, will be replaced with J2802.

Additionally, effective for dates of service on and after April 1, 2025, the following specialty pharmacy medications will be removed from the Designated Medical Specialty Pharmacy Drug List and will no longer need to be obtained from our contracted medical specialty pharmacy:

HCPCS

Description

Brand name

J1950

INJ LEUPROLIDE ACETATE PER 3.75 MG

LUPRON DEPOT

J9217

LEUPROLIDE ACETATE 7.5 MG

ELIGARD/LUPRON DEPOT

J9218

LEUPROLIDE ACETATE, PER 1 MG

LUPRON

To access the current Designated Medical Specialty Pharmacy Drug List, please visit anthem.com/provider, select Providers, select Forms and Guides (under the Provider Resources column), select your state, scroll down, and select Pharmacy in the Category dropdown. The Designated Medical Specialty Pharmacy Drug List may be updated periodically by Anthem.

If you have questions or would like to discuss the terms and conditions to be included as a designated specialty pharmacy network provider, please contact your contract manager with Anthem. Thank you for your continued participation in the Anthem networks and the services you provide to our members.

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWI), Compcare Health Services Insurance Corporation (Compcare), and Wisconsin Collaborative Insurance Company (WCIC). BCBSWI underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: February 2025 Provider Newsletter