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Is Specialty Pharmacy Medical Mgmt (SPMM) reviewing for drugs covered under the pharmacy benefit?

April 26, 2017benefit Covered drugs medical mgmt pharmacy reviewing specialty spmm

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Is Specialty Pharmacy Medical Mgmt (SPMM) reviewing for drugs covered under the pharmacy benefit?

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No. SPMM only reviews for medical necessity for specialty medications covered under the members’ medical benefits. Pharmacy prior authorization requests are still managed by Anthem Blue Cross’ prescription drug plan.