November 06, 2017
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement
Beginning January 1, 2018, Anthem Blue Cross will implement a Specialty Pharmacy program for CalPERS, which will include a review of the requested site of care for certain pharmacy services.
In its notice, Anthem states that infusion and injection services can often be safely and effectively provided in a physician’s office, Ambulatory Infusion Suite or at home by a licensed Home Infusion Therapy provider. During pre-service utilization review, Anthem will determine if an infusion or injection service can safely be given to a patient in a lower level of care or lower cost setting/place of care, and will deny requests for higher level of care or higher cost setting/place of care, unless medically necessary.