Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Back
New Specialty Pharmacy Medical Step Therapy Requirements (Healthy Blue + Medicare HMO D-SNP) February 02, 2023 Pharmacy Blue Medicare Medical Policy & Clinical Guidelines

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).

Clinical Criteria GuidelinesPreferred drug(s)Nonpreferred drugs(s)
CC-0072 (PDF)

Avastin
Byooviz
Cimerli
Eylea
Lucentis
Vabysmo

Beovu
Macugen