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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · OH · Oncology, Hematology, Rheumatology +7 moreMedium impact

[Ohio] Clinical Criteria updates

Act
by Nov 29, 2026
Effective date
Nov 29, 2026
Identified
Oct 25, 2026

Summary

Anthem Blue Cross and Blue Shield has revised 60 clinical criteria policies for medical drug benefits effective November 29, 2026. These updates affect medical necessity requirements for specialty medications across oncology, hematology, rheumatology, neurology, and other therapeutic areas. Billing teams must verify current authorization requirements through Anthem's separate authorization notice and confirm applicability to affected members.

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What to do

by Nov 29, 2026 · 4 steps
01Billing and authorization teams should review revised clinical criteria for all 60 affected policies (CC-0001 through CC-0310) on Anthem's Clinical Criteria page to identify any changes to medical necessity requirements for specialty medications in your practice.
02Contact Anthem via the provided email for questions about specific authorization rule changes, as those are communicated separately from clinical criteria updates.
03Verify which affected medications your practice prescribes and ensure prior authorization workflows align with the revised criteria.
04Note: These criteria apply only to medical drug benefits, not pharmacy services.

Original notice

[Ohio] Clinical Criteria updates
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

See all Anthem BCBS changes →
[New York] Clinical Criteria updates (November 2026 Newsletter)MediumNo effective date · Provider Bulletin[Virginia] Clinical Criteria updates (November 2026 Newsletter)LowNo effective date · Provider Bulletin[California] Clinical Criteria updates (November 2026 Newsletter)MediumNo effective date · Provider Bulletin[California] Clinical Criteria updatesMediumEffective Nov 29, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesOH policy changesOncologyHematologyRheumatologyNeurologyCardiologyEndocrinologyDermatologyGastroenterologyInfectious DiseasePediatrics

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