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Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list for 2020 

September 30, 2019    

Effective January 1, 2020, AmeriHealth Pennsylvania will update its list of specialty drugs that require member cost-sharing (e.g., copayment, deductible, and coinsurance). Cost-sharing applies to select medical benefit specialty drugs for members who are enrolled in Commercial FLEX products and other select plans. The member’s cost-sharing amount is based on the terms of the member’s benefit contract. In accordance with your Provider Agreement, it is the provider’s responsibility to verify a member’s individual benefits and cost-share requirements.

The cost-share list will be expanded to include 186 drugs, including the following additions:

  • abicipar*
  • brolucizumab*
  • cabotegravir*
  • cosyntropin depot*
  • crizanlizumab*
  • eptacog-beta*
  • eptinezumab*
  • Lapelga (pegfilgrastim)*
  • leuprolide mesylate*
  • luspatercept*
  • RVT-802*
  • Synojoynt™ (1% sodium hyaluronate solution)
  • Triluron™ (sodium hyaluronate)
  • Xembify® (immune globulin subcutaneous, human-klhw)
  • Zynteglo™ (betibeglogene darolentivec)*

The updated list of specialty drugs with cost-sharing is available on our website.

*Pending approval from the U.S. Food and Drug Administration (FDA).

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