The following specialty drugs, which have been approved by the U.S. Food and Drug Administration (FDA) and are eligible for coverage under the medical benefit, will require precertification as of October 1, 2020, for AmeriHealth New Jersey members and as of September 1, 2020, for AmeriHealth Pennsylvania members:
- Darzalex Faspro™ (daratumumab and hyaluronidase human-fihj)
- Nyvepria™ (pegfilgrastim-apgf)
- Phesgo™ (pertuzumab/trastuzumab/hyaluronidase-zzxf)
AmeriHealth is developing medical policies for these drugs. In the absence of a published medical policy, coverage requests for these drugs will be subject to review in accordance with the FDA-approved indications and AmeriHealth-recognized compendia.
Updated precertification lists that reflect the above-mentioned changes will be posted on our website for AmeriHealth New Jersey and AmeriHealth Pennsylvania.