Material adverse change (MAC)

The Empire BlueCross BlueShield (Empire) preservice clinical review of nononcology specialty pharmacy drugs will be managed by the Medical Specialty Drug Review team at Empire. Oncology drugs will be managed by Carelon Medical Benefits Management, Inc.* (formerly AIM Specialty Health®), a separate company.


The following Clinical Criteria document was endorsed at the December 21, 2022, Clinical Criteria meeting. To access the Clinical Criteria information, visit this link.


Revised Clinical Criteria effective June 1, 2023

The following Clinical Criteria was revised and might result in services previously covered but may now be classified as not medically necessary:

  • CC-0072 Vascular Endothelial Growth Factor (VEGF) Inhibitors

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.


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March 2023 Empire Provider News