The ACR recently had an opportunity to speak with Anthem leadership to follow up on concerns about specialty pharmacy acquisition mandates being implemented by Anthem plans in California and New York. Anthem clarified that they do not expect these mandates to impact community-based providers.
Beginning in December 2020, Anthem plans in certain states will require select hospital outpatient facilities to obtain specialty drugs through CVS Specialty Pharmacy. The policy will impact a minority of facilities whose current contracted rates significantly exceed Medicare rates. Anthem sent a letter with additional details to all impacted providers. For specific questions, practices are encouraged to contact their provider representatives directly.
Anthem will implement this policy in California in December 2020, followed by New York and Kentucky in January 2021. They anticipate future expansion to additional states; however, the scope of the policy will remain the same and it is not expected to impact community-based providers.
For questions regarding this policy or other insurance coverage concerns, contact [email protected].
