REMINDER: Changes to the process for Medical Non-Oncology Specialty Drug reviews effective June 15, 2019

In the June newsletter we announced the transition of the medical non-oncology specialty drug review process from AIM Specialty Health^® (AIM) to Anthem Blue Cross and Blue Shield (Anthem)’s medical specialty drug review team, effective June 15, 2019. Here’s a reminder of the changes.

 

What has changed?

• Beginning June 15, 2019 all requests, regardless of service date, providers need to submit a new prior authorization request by contacting Anthem’s medical specialty drug review team:
  • o by phone at 1-833-293-0659 or
  • o by fax at 1-888-223-0550 or
  • o Online access at Availity.com available 24/7.
• All inquiries about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration are being managed by Anthem’s medical specialty drug review team.

 

What has not changed?

• AIM continues to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
• Clinical criteria for medical non-oncology specialty drugs continues to reside on the Clinical Criteria page on anthem.com
• Post Service Clinical Coverage Reviews and Grievance and Appeals process and teams have not changed.

 

Here is a summary of the medical specialty drug changes, beginning June 15, 2019:

Action	Contact
Submit a new prior authorization request for medical specialty drug reviews	Call Anthem at 1-833-293-0659 OR Fax us at 1-888-223-0550 for OR Access online at www.availity.com available 24/7
Inquire about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration	Call Anthem at 1-833-293-0659