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CMA urges Anthem to delay specialty medication policy

June 30, 2020
Area(s) of Interest: Practice Management Drug Prescribing/Dispensing 


The California Medical Association (CMA) and a number of specialty medical associations have asked Anthem Blue Cross to delay implementation of a new policy requiring that specialty pharmacy medications administered in the office or outpatient hospital setting be obtained exclusively through CVS Specialty pharmacy. The new policy applies to Anthem’s commercial HMO and Medi-Cal managed care products effective with July 1, 2020, dates of service where Anthem is financially at risk for the specialty medications.

Physicians practices throughout the state have faced an unprecedented threat to their viability as the result of the COVID-19 pandemic. Many have been on the front lines caring for COVID-19 patients and others have had to figure out how to quickly implement telehealth to provide care to their patients and keep their doors open.

“As the health care system is in the early phases of reopening, physician practices remain significantly disadvantaged and unprepared to implement new policies at this juncture,” the letter said. “During the COVID-19 state of emergency, CMA has called upon all California payors to consider delaying or halting the implementation of new operational or administrative requirements, like this policy, which may significantly impact physician practices during this difficult time.“

CMA is also concerned that while Anthem first announced the policy change for its commercial HMO in April, it doesn’t appear that the payor has issued any further reminders to physicians about the July 1 effective date. Physicians that are unaware of the policy’s implementation and do not utilize CVS Specialty will, according to the notice, have their claims denied. These specialty medications are hard costs that the physician will have no way of recouping. CMA and the specialty societies are extremely concerned that implementation of this policy will cause further financial damage to practices at a time when 75% of physicians are experiencing a revenue decline of 50% or greater due to the COVID-19 pandemic.

While Anthem has agreed to a meeting to discuss these concerns, the effective date of the policy is just one day away. As such, CMA is strongly urging Anthem to delay implementation to allow adequate time to discuss the concerns in more detail and ensure patient care and physician practices are not significantly harmed by this policy. 

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