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New Specialty Pharmacy Medical Step Therapy Requirements (Healthy Blue + Medicare HMO D-SNP)
Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
Effective April 1, 2023, the following part B medications from the current Clinical Criteria Guidelines will be included in our medical step therapy precertification review process. Step therapy review will apply upon precertification initiation in addition to the current medical necessity review (as is current procedure). Step therapy will not apply for members who are actively receiving medications listed below.
Clinical Criteria CC-0002 currently has a step therapy preferring Neulasta, Neulasta OnPro, and the biosimilar Udenyca. This update is to notify that Rolvedon and the new biosimilars Fylnetra and Stimufend will be added to existing step therapy as non-preferred agents.
Clinical Criteria Guidelines are publicly available on the provider website. Visit Anthem's Clinical Criteria page to search for specific criteria.
Clinical UM Guidelines | Preferred drug(s) | Nonpreferred drug(s) |
|---|---|---|
Neulasta Neulasta OnPro Udenyca | Fulphila Fylnetra Nyvepria Rolvedon Stimufend Ziextenzo |
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