MP/CG Update/Notice - December 2022 Form

P.O. Box 4330 Woodland Hills, CA 91365

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
CABC-CM-012638-22-CPN12421 December 2022

December 1, 2022

Dear Provider:

Specialty pharmacy updates for Anthem Blue Cross (Anthem) are listed below.

Prior authorization clinical review of non-oncology use of specialty pharmacy drugs is managed by Anthem’s Medical Specialty Drug review team.

Important to note: Currently, your patients may be receiving these medications without prior authorization. As of the effective date below, you may be required to request prior authorization review for your patients continued use of these medications. Inclusion of National Drug Code (NDC) code on your claim will help expedite claim processing of drugs billed with a Not Otherwise Classified (NOC) code.

Step therapy updates

Clinical criteria ING-CC-0182 (Iron Agents) currently has step therapy in place preferring Ferrlecit, Infed and Venofer.

Effective for dates of service on and after March 1, 2023, the status of Infed in current criteria documents will be changing in our existing specialty pharmacy medical step therapy review process. This update is to notify that Infed will change to non-preferred. Also, effective for dates of service on or after December 1, 2022, Feraheme (ferumoxytol) will change to preferred for both brand and generic.

Clinical Criteria

Status Drug HCPCS or CPT Code(s) ING-CC-0182 Non-preferred Infed (iron dextran) J1750 ING-CC-0182 Non-preferred Injectafer (ferric carboxymaltose) J1439 ING-CC-0182 Non-preferred Monoferric (ferric derisomaltose) J1437 ING-CC-0182 Preferred Feraheme (ferumoxytol) Q0138 ING-CC-0182 Preferred Ferrlecit (sodium ferric gluconate/sucrose complex) J2916 ING-CC-0182 Preferred Venofer (iron sucrose) J1756

Access our Clinical Criteria at https://www.anthem.com/ms/pharmacyinformation/clinicalcriteria.html to view the complete information for these site of care updates.

Prior Authorization will be required effective March 1, 2023, for members not eligible for AIM programs for the following (SB535 exclusions apply where noted): • GENE.00020 Gene Expression Profile Tests for Multiple Myeloma (SB535) *Effective July 1, 2022, in compliance with California SB 535, Anthem Blue Cross and its delegated entities regulated by the California Department of Managed Health Care and the California Department of Insurance will no longer require prior authorization for biomarker testing, including biomarker testing for cancer progression and recurrence, for members with advanced or metastatic stage 3 or 4 cancer. Post service review of medical necessity for biomarker testing for advanced or metastatic stage 3 or 4 cancer members is not permitted, only confirmation of advanced or metastatic stage 3 or 4 cancer is permitted. We thank you for your continued efforts on behalf of our members and your partnership toward improved access to quality health care for Californians.
Sincerely,

John Yao, MD, MPH, MBA, MPP, FACP
Chief Medical Officer