Anthem Blue Cross site of service reviews to now include pharmacy services for CalPERS members

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.

Join CMA Today!

Explore why over 44,000 California physicians have joined CMA to advocate for patients, the medical profession and the future of health care.

Was this page helpful?