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.