Updates to the medical benefit specialty drug cost-share list effective July 1, 2021

April 8, 2021

Effective July 1, 2021, 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 207 drugs, with the following additions:

  • anifrolumab* – Immunological agents
  • avalglucosidase alfa* – Enzyme replacement agents
  • Cosela® (trilaciclib) – Miscellaneous therapeutic agents
  • Nivestym® (filgrastim-aafi) – Neutropenia
  • Uptravi IV (selexipag)* – Pulmonary arterial hypertension

For drugs that are pending approval from the U.S. Food and Drug Administration (FDA), their official brand names may be different than the names listed above. All names were valid at the time of article publication.

In addition, the following changes will be made to the list:

  • cabotegravir will be changed to Cabenuva, to reflect its current brand name
  • evinacumab will be changed to Evkeeza™, to reflect its current brand name
  • lumasiran will be changed to Oxlumo™, to reflect its current brand name

The above-mentioned changes will be available on our website.

*Pending approval from the FDA.