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:
- cosyntropin depot*
- Lapelga (pegfilgrastim)*
- leuprolide mesylate*
- 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).