As a reminder, 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 for AmeriHealth Pennsylvania members, require precertification as of September 1, 2020:
- 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.
These changes are reflected in an updated precertification requirement list, which is available on our website.