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51+: Some Self-Administered Specialty Rx Moved to Rx Benefits

Oct 23, 2014

Starting January 1, 2015 at renewal, self-administered drugs listed in the attac​hed chart will no longer be covered under the medical benefit for Anthem Blue Cross members in some commercial large group health care coverage products.

Coverage for these self-administered drugs should be submitted for review under the member’s pharmacy benefit. 

Members with a medical claim for any drug listed in the chart  will get a let​ter telling them the drug is not covered under their medical benefit. The letter informs the member that claims for the drug should be submitted for review under their pharmacy benefit. Anthem will also include instructions on how to get started with Accredo Specialty Pharmacy, the Anthem Blue Cross specialty pharmacy in our network.

This change applies to large group members enrolled in fully insured PPO (Preferred Provider Organization), CDHP (Consumer-driven health plan), EPO (Exclusive Provider Organization) and FFS (Fee-for-service) plans.

For questions, please ​contact a member of your b&p Sales Team - 888.722.3373.

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