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CommercialCoverageMedium impact

[New York] Clinical Criteria updates for specialty pharmacy

Anthem BCBS·NY·Pharmacy
Effective date
Not stated
We identified it
May 3, 2026
Days to comply
—

Summary

Anthem updated clinical criteria for specialty pharmacy medications in New York. The billing team should review current specialty drug authorization processes to ensure compliance with new coverage requirements.

Action Required

Action needed
Immediately: Review the updated clinical criteria at the provided URL to identify changes to specialty pharmacy coverage requirements. Update prior authorization workflows for affected specialty medications. Verify current specialty drug claims align with new criteria before submission.

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