AmeriHealth is constantly evaluating our policies and industry trends to identify opportunities to make specialty drugs more affordable without limiting members' access to life-saving medications. As a result, AmeriHealth is changing how we manage the colony-stimulating factors (CSFs) drug class.
Effective April 1, 2021, AmeriHealth will designate the following CSF drugs as preferred products:
- Long-acting CSFs
- Fulphila® (pegfilgrastim-jmdb)
- Neulasta® (pegfilgrastim)
- Udenyca® (pegfilgrastim-cbqv)
- Short-acting CSFs
- Granix® (tbo-filgrastim)
- Zarxio® (filgrastim-sndz)
How this affects your patients
To preserve member continuity of care, AmeriHealth will continue to cover all preferred and non-preferred CSFs for members who are currently receiving these products. This means that members who are currently receiving a non-preferred filgrastim or pegfilgrastim product (e.g., Neupogen®, Nivestym®, Nyvepria®, Ziextenzo®) will not be required to transition to a preferred product.
However, due to new requirements that go into effect for all members on January 1, 2021, all requests for Neupogen and Nivestym must be reviewed for precertification approval from AmeriHealth.
As of April 1, 2021, all new requests for long-acting and short-acting CSFs will only be approved for the preferred products listed above, unless the member has a demonstrated intolerance or contraindication to the preferred products.
The AmeriHealth medical policy on pegfilgrastim will be updated to reflect new coverage criteria for preferred products. A new AmeriHealth medical policy on filgrastim is in development. These policies will be posted as Notifications on the Medical and Claim Payment Policy Portal on December 31, 2020, and will go into effect April 1, 2021:
- #08.01.32d: Pegfilgrastim (Neulasta®) and related biosimilars
- #08.01.73: Filgrastim (Neupogen®) and related biosimilars, and tbo-filgrastim (Granix®)
AmeriHealth will continue to investigate opportunities to establish preferred products that ensure value and access to our customers.