Anthem BCBSMedium ImpactCoverage
[New York] Clinical Criteria updates for specialty pharmacy
Published May 3, 2026
AI Summary
Anthem has updated clinical criteria for specialty pharmacy services in New York. The billing team should review these changes as they may affect prior authorization requirements, coverage determinations, or documentation needs for specialty medications.
Action Required
Review the updated clinical criteria for specialty pharmacy at the provided URL to identify specific changes to prior authorization requirements, coverage criteria, or documentation needs. Update billing workflows and staff training as needed based on the specific criteria changes outlined in the full policy.
Plan Types
Commercial, Medicare Advantage
States
NY
Specialties
all-specialties