Archival of several medical policies

December 2, 2020

Effective January 1, 2021, the following policies will be archived because the precertification requirement for the applicable drugs will be removed:

  • #08.01.19f: Siltuximab (Sylvant®)
    • The code J2860 Injection, siltuximab, 10 mg is eligible for coverage.
  • #08.00.98e: Eribulin Mesylate (Halaven®)
    • The code J9179 Injection, eribulin mesylate, 0.1 mg is eligible for coverage.
  • #08.00.96e: Cabazitaxel (Jevtana®)
    • The code J9043 Injection, Cabazitaxel, 1 mg is eligible for coverage.

Changes to the precertification requirement lists that become effective January 1, 2021, are posted on our website for AmeriHealth New Jersey and AmeriHealth Pennsylvania.

Effective January 1, 2021, Medical Policy #08.01.24a: Deoxycholic Acid (KybellaTM) will be archived because the information in this policy is now addressed in Medical Policy #12.01.03a: Cosmetic Procedures. The code J0591 Injection, deoxycholic acid, 1 mg will remain a cosmetic service.

Effective January 4, 2021, Medical Policy #08.00.88f: Ofatumumab (Arzerra®) will be archived. The code J9302 Injection, Ofatumumab acid, 10 mg is eligible for coverage.

Precertification information on the above policies was previously communicated in a Partners in Health UpdateSM article.