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.

Effective April 1, 2023, the following Medicare 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 consumers who are actively receiving medications listed below. 

Clinical Criteria CC-0072 currently has a step therapy preferring Avastin and Eylea. This update is to notify that Byooviz, Cimerli, Lucentis, and Vabysmo will be added to existing step therapy as preferred agents.

Clinical Criteria guidelines are publicly available. Visit Anthem's Clinical Criteria to search for specific criteria. For more information, please see Anthem's Medical Drug Clinical Criteria (PDF).