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Anthem Clarifies Specialty Pharmacy Mandate

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These last few weeks, CRA has been working tirelessly to follow-up with and verify the details of Anthem’s specialty pharmacy policy that will be implemented for PPO and EPO subscribers effective December 1, 2020. We are happy to report that we received the following email from April Barber, Regional Vice President, Provider Solutions at Anthem that clarifies who will be impacted by this mandate:

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Thank you for taking the time to talk with me regarding Anthem’s new requirement to obtain certain drugs from CVS Specialty Pharmacy. I am hoping to clarify the scope and objective of this initiative and if your practice is impacted.

In order to address the rising cost of specialty drug prices, Anthem Blue Cross is requiring certain specialty drugs to be obtained from designated specialty pharmacy providers. For select specialty drugs administered in a physician’s office or outpatient setting, providers are required to acquire specialty medications from CVS Specialty Pharmacy if they are not participating in the designated specialty pharmacy network. Practices and facilities can join the designated SRx network if they meet network terms and conditions, including ASP price threshold. 

On September 1, 2020, Anthem Blue Cross notified practices [with patients in Anthem commercial EPO and PPO plans] that are impacted by this initiative of this new requirement who did not meet the terms to participate in the designated SRx network. If you did not receive this letter, your practice can continue to administer and bill drugs per your standard processes.

If your practice received a letter indicating you must acquire specialty drugs through the Designated SRx Network, please contact your contracting representative regarding the terms and conditions required to be eligible.

We apologize for the confusion and frustration the information you received about this initiative may have caused. If you would like to confirm if your practice is included in the designated SRx network, or if you have any further questions or concerns, please do not hesitate to contact April Barber, Regional Vice President, Provider Solutions, at April.Barber@Anthem.com. Thank you again for contacting us.

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On behalf of the CRA Board of Directors, I want to thank and applaud our membership for mobilizing and taking action to communicate our concern for our patients to Anthem Blue Cross. We are gratified to know that our PPO and EPO patients will have access to their treatment and care in our offices without change.

CRA Issues Letters to California Business Advocacy Organizations Warning Them of Consequences of Anthem Blue Cross Mandate

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This week, the CRA issued letters to the following business advocacy organizations outlining the impact to businesses and employees if the Anthem policy goes into effect on December 1, 2020:

If you have any questions about how this new policy will affect your patients, please contact us at info@calrheum.org.

CRA Press Release – October 29, 2020 re: Anthem SPP Mandate

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The CRA issued a press release today outlining the dangerous policy change Anthem plans to implement for PPO and EPO subscribers. We have sent a letter to Beth Andersen, Anthem’s California Plan President requesting a meeting and reconsideration of a proposed policy adjustment that will force patients to utilize Anthem’s preferred specialty pharmacies, making it nearly impossible for certain treatments (specifically infusion therapy) to be conducted in physician offices – under their care.

Click here for the press release

ANTHEM’S SPECIALTY PHARMACY MANDATE

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It was brought to the CRA’s attention that Anthem Blue Cross recently notified physicians that effective December 1, 2020, it will expand its specialty medication policy to also apply to its commercial PPO and EPO plans. This new PPO policy, which goes into effect for dates of service on or after December 1, 2020, is an extension of the policy previously implemented in July 2020 for Anthem’s commercial HMO and Medi-Cal managed care plans. It will require that almost all specialty pharmacy medications that rheumatologists administer in their offices be obtained exclusively through CVS Specialty pharmacy. This mandate will terminate the buy and bill model. These claims will be rejected by Anthem and will only be reimbursed the administration fees at the usual rate. This is a huge concern as this change may potentially displace patients and disrupt their access to care.

The CRA is actively working with several specialty medical associations asking that they rescind the policy or delay to ensure our patients continue to their patient care and treatment without interruption.

Please click here to read the letter CRA has sent to Anthem.

Check back for more updates.