Empire BlueCross BlueShield’s (“Empire”) pre-service clinical review of non-oncology specialty pharmacy drugs will be managed by Empire’s medical specialty drug review team. Oncology drugs will be managed by AIM Specialty Health (AIM), a separate company.


The following Clinical Criteria documents were endorsed at a Clinical Criteria meeting. To access the clinical criteria information please click here.


Revised Clinical Criteria effective August 1, 2021

The following clinical criteria were reviewed with no significant change to the medical necessity indications or criteria.

  • ING-CC-0037 Kanuma (sebelipase alfa)
  • ING-CC-0043 Monoclonal Antibodies to Interleukin-5
  • ING-CC-0057 Krystexxa (pegloticase)
  • ING-CC-0066 Monoclonal Antibodies to Interleukin-6
  • ING-CC-0068 Growth Hormone
  • ING-CC-0069 Egrifta (tesamorelin)
  • ING-CC-0111 Nplate (romiplostim)
  • ING-CC-0137 Cablivi (caplacizumab-yhdp)
  • ING-CC-0153 Adakveo (crizanlizumab)
  • ING-CC-0162 Tepezza (teprotumumab-trbw)




Featured In:
August 2021 Newsletter